Form 1099-G

2016

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 2016

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 federal identification number RECIPIENT’S identification number

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

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

Form 1099-G

2016

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 federal identification number RECIPIENT’S identification number

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

2016

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 

Internal Revenue 

Service. 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 federal identification number RECIPIENT’S identification number

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 identification number. For your protection, this form may show 

only the last four digits of your social security number (SSN), individual taxpayer 

identification number (ITIN), adoption taxpayer identification number (ATIN), or 

employer identification number (EIN). However, the issuer has reported your 

complete identification number 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 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 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 2015 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 taxpayer identification number 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 Form 1040 on the “Other income” line. See the Form 1040

instructions.

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 Instructions for Schedule F (Form 1040) 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 Instructions for Schedule F (Form 1040).

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.
 

Form 1099-G

2016

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 federal identification number RECIPIENT’S identification number

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

2016

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 2016

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 federal identification number RECIPIENT’S identification number

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
Instructions for Payer

To complete Form 1099-G, use: 

• the 2016 General Instructions for Certain Information 

Returns, and 

• the 2016 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, 3922, or 5498 that you print from the IRS 

website.

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

by January 31, 2017.

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

2017. If you file electronically, the due date is March 31, 

2017. 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.

Need help? If you have questions about reporting on

Form 1099-G, call the information reporting customer

service site toll free at 1-866-455-7438 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).