Attention: 

Copy A of this form is provided for informational purposes only. Copy A appears in red, 

similar to the official IRS form. The official printed version of Copy A of this IRS form is 

scannable, but the online version of it, printed from this website, is not. Do not print and file 

copy A downloaded from this website; a penalty may be imposed for filing with the IRS 

information return forms that can’t be scanned. See part O in the current General 

Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more 

information about penalties.

Please note that Copy B and other copies of this form, which appear in black, may be 

downloaded and printed and used to satisfy the requirement to provide the information to 

the recipient.

To order official IRS information returns, which include a scannable Copy A for filing with 

the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on 

Employer and Information Returns, and we’ll mail you the forms you request and their 

instructions, as well as any publications you may order.

Information returns may also be filed electronically using the IRS Filing Information Returns 

Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act 

Information Returns (AIR) program (visit www.IRS.gov/AIR).

See IRS Publications 1141, 1167, and 1179 for more information about printing these tax 

forms.
 

Form 1099-G

2021

Cat. No. 14438M

Certain 

Government 

Payments

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0120

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 2021

General

Instructions for

Certain Information

Returns.

8686 VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions) 2nd TIN not.

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

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

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 Check if box 2 is 

trade or business 

income ▶

9 Market gain

$

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

$

$

Form 1099-G www.irs.gov/Form1099G

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

Form 1099-G

2021

Certain 

Government 

Payments

Copy 1

For State Tax 

Department

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0120

VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

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

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 Check if box 2 is 

trade or business 

income ▶

9 Market gain

$

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

$

$

Form 1099-G www.irs.gov/Form1099G
 

Form 1099-G

2021

Certain 

Government 

Payments

Copy B

For Recipient

Department of the Treasury - Internal Revenue Service

This is important tax 

information and is 

being furnished to the 

IRS. If you are required 

to file a return, a 

negligence penalty or 

other sanction may be 

imposed on you if this 

income is taxable and 

the IRS determines that 

it has not been 

reported.

OMB No. 1545-0120

CORRECTED (if checked)

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

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

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 If checked, box 2 is 

trade or business 

income ▶

9 Market gain

$

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

$

$

Form 1099-G (keep for your records) www.irs.gov/Form1099G
Instructions for Recipient

Recipient’s taxpayer identification number (TIN). For your protection, this 

form may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). 

However, the issuer has reported your complete TIN to the IRS.

Account number. May show an account or other unique number the payer has 

assigned to distinguish your account.

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 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 (a) it was credited to your state or local estimated tax, (b) 

it was offset against federal or state debts, (c) it was offset against other offsets, 

or (d) you made a charitable contribution from your refund, it is still taxable if it 

was deducted. If you received interest on this amount, you may 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 3. Identifies the tax year for which the box 2 refunds, credits, or offsets

shown were made. If there is no entry in this box, the refund is for 2020 taxes.

Box 4. Shows backup withholding or withholding you requested on

unemployment compensation, Commodity Credit Corporation (CCC) loans, or

certain crop disaster payments. Generally, a payer must backup withhold on

certain payments if you did not give your TIN to the payer. See Form W-9 for 

information on backup withholding. Include this amount on your income tax 

return as tax withheld.

Box 5. Shows reemployment trade adjustment assistance (RTAA) payments you 

received. Include on the “Other income” line of Schedule 1 (Form 1040).

Box 6. Shows taxable grants you received from a federal, state, or local

government.

Box 7. Shows your taxable Department of Agriculture payments. If the payer

shown is anyone other than the Department of Agriculture, it means the payer

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

represent the entire agricultural subsidy payment received on your behalf by the 

nominee, or it may be your pro rata share of the original payment. See Pub. 225 

and the Schedule F (Form 1040) instructions for information about where to 

report this income. Partnerships, see Form 8825 for how to report.

Box 8. If this box is checked, the amount in box 2 is attributable to an income

tax that applies exclusively to income from a trade or business and is not a tax

of general application. If taxable, report the amount in box 2 on Schedule C or F 

(Form 1040), as appropriate.

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

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

Boxes 10a–11. State income tax withheld reporting boxes.

Future developments. For the latest information about developments related to 

Form 1099-G and its instructions, such as legislation enacted after they were 

published, go to www.irs.gov/Form1099G.

FreeFile. Go to www.irs.gov/FreeFile to see if you qualify for no-cost online 

federal tax preparation, e-filing, and direct deposit or payment options.
 

Form 1099-G

2021

Certain 

Government 

Payments

Copy 2

To be filed with 

recipient's state 

income tax 

return, when 

required.

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0120

VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

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

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 Check if box 2 is 

trade or business 

income ▶

9 Market gain

$

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

$

$

Form 1099-G www.irs.gov/Form1099G
 

Form 1099-G

2021

Certain 

Government 

Payments

Copy C

For Payer

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0120

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 2021

General

Instructions for

Certain Information

Returns.

VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions) 2nd TIN not.

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

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

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 Check if box 2 is 

trade or business 

income ▶

9 Market gain

$

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

$

$

Form 1099-G www.irs.gov/Form1099G
Instructions for Payer

To complete Form 1099-G, use: 

• The 2021 General Instructions for Certain Information 

Returns, and 

• The 2021 Instructions for Form 1099-G.

To order these instructions and additional forms, go 

to www.irs.gov/Form1099G.

Caution: Because paper forms are scanned during

processing, you cannot file Forms 1096, 1097, 1098, 

1099, 3921, or 5498 that you print from the IRS website.

Due dates. Furnish Copy B of this form to the recipient 

by January 31, 2022.

File Copy A of this form with the IRS by February 28, 

2022. If you file electronically, the due date is March 31, 

2022. To file electronically, you must have software that 

generates a file according to the specifications in Pub. 

1220. The IRS does not provide a fill-in form option for 

Copy A.

Need help? If you have questions about reporting on

Form 1099-G, call the information reporting customer

service site toll free at 866-455-7438 or 304-263-8700 

(not toll free). Persons with a hearing or speech 

disability with access to TTY/TDD equipment can call 

304-579-4827 (not toll free).