$

PAYER’S federal identification number RECIPIENT’S identification number 3 Box 2 amount is for tax year 4 Federal income tax withheld

$

RECIPIENT’S name 6 Taxable energy grants

$

8 Check if box 2 is

trade or business

income 

Street address (including apt. no.) 7 Agriculture payments

$

City, state, and ZIP code

Account number (see instructions)

Form 1099-G Department of the Treasury - Internal R

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on Th

Cat. No. 14438M

Form 1099-G

5

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ATAA payments

$

9 Market gain

$

10a State 10b State identification no. 11 State income tax withheld
PAYER’S federal identification number RECIPIENT’S identification number

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-G Department of the Treasury - Internal R

This 

in

being 

I

Se

required 

a neglig

other s

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the IRS 

(keep for your records)

Fo

$

Box 2 amount is for tax year 4 Federal income tax withheld

$

6 Taxable energy grants

$

8 Check if box 2 is

trade or business

income 

7 Agriculture payments

$

Form 1099-G

5 ATAA payments

$

9 Market gain

$

10a State 10b State identification no. 11 State income tax withheld

3
Box 2. Shows refunds, credits, or offsets of state or local income tax you

received. It may be taxable to you if you deducted the state or local income

tax paid on Schedule A (Form 1040). Even if you did not receive the amount

shown, for example, because it was credited to your state or local estimated

tax, it is still taxable if it was deducted. If you received interest on this amount,

you should receive Form 1099-INT for the interest. However, the payer may

include interest of less than $600 in the blank box next to Box 9 on Form

1099-G. Regardless of whether the interest is reported to you, report it as

interest income on your tax return. See your tax return instructions.

Box 6. Shows taxable energy grants you received from a federa

local government.

Box 7. Shows your taxable Department of Agriculture payments

shown is anyone other than the Department of Agriculture, it m

has received a payment, as a nominee, that is taxable to you. T

represent the entire agricultural subsidy payment received on y

the nominee, or it may be your pro rata share of the original pa

Pub. 225 and the instructions for Schedule F (Form 1040) for in

where to report this income. Partnerships, see Form 8825 for h

Box 8. If this box is checked, the amount in box 2 is attributab

tax that applies exclusively to income from a trade or business 

of general application. If taxable, report the amount in box 2 on 

C-EZ, or F (Form 1040), as appropriate.

Box 5. Shows alternative trade adjustment assistance (ATAA) p

received. Include on Form 1040 on the “Other income” line. See 

1040 instructions.

Box 1. Shows the total unemployment compensation paid to you this year.

Combine the box 1 amounts from all Forms 1099-G and report the total as

income on the unemployment compensation line of your tax return. Except as

explained below, this is your taxable amount. If you are married filing jointly,

each spouse must figure his or her taxable amount separately. If you expect to

receive these benefits in the future, you can ask the payer to withhold federal

income tax from each payment. Or, you can make estimated tax payments.

For details, see Form 1040-ES. If you made contributions to a governmental

unemployment compensation program or to a governmental paid family leave

program and received a payment from that program, the payer must issue a

separate Form 1099-G to report this amount to you. If you itemize deductions,

you may deduct your contributions on Schedule A (Form 1040) as taxes paid.

If you do not itemize, you only need to include in income the amount that is in

excess of your contributions.

Box 9. Shows market gain on CCC loans whether repaid using 

certificates. See the instructions for Schedule F (Form 1040).

Boxes 10a–11. State income tax withheld reporting boxes.
PAYER’S federal identification number RECIPIENT’S identification number

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-G Department of the Treasury - Internal R

F

a

N

In

Certai

$

Box 2 amount is for tax year 4 Federal income tax withheld

$

6 Taxable energy grants

$

8 Check if box 2 is

trade or business

income 

7 Agriculture payments

$

Form 1099-G

5 ATAA payments

$

9 Market gain

$

10a State 10b State identification no. 11 State income tax withheld

3
general instructions gives a quick guide to which form

must be filed to report a particular payment. To order

these instructions and additional forms, visit the IRS

website at www.irs.gov or call 1-800-TAX-FORM

(1-800-829-3676).

Due dates. Furnish Copy B of this form to the

recipient by January 31, 2011.

Forms 1098, 1099, 3921, 3922, 5498, 8935, 

Electronically. IRS does not provide a fill-in f

option.

Caution: Because paper forms are scanned during

processing, you cannot file Forms 1096, 1098, 1099,

3921, 3922, or 5498 that you print from the IRS

website.

Need help? If you have questions about rep

Form 1099-G, call the information reporting 

service site toll free at 1-866-455-7438 or

304-263-8700 (not toll free). For TTY/TDD eq

call 304-579-4827 (not toll free). The hours o

are Monday through Friday from 8:30 a.m. to 

p.m., Eastern time.