CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0120 1 Unemployment compensation

$

State or local income tax

refunds, credits, or offsets

2

$

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 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 Revenue Service

8686 VOID

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

Cat. No. 14438M

Form 1099-G

Certain

Government

Payments

5

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the 2009

General Instructions

for Forms 1099,

1098, 3921, 3922,

5498, and W-2G.

ATAA payments

$

2009

9 Market gain

$
CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0120 1 Unemployment compensation

Certain

Government

Payments

$

State or local income tax

refunds, credits, or offsets

2

$

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 grants

$

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 Revenue Service

Copy B

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.

(keep for your records)

For Recipient

Form 1099-G

5

8 Box 2 is trade or

business income 

ATAA payments

$

2009

9 Market gain

$
Instructions for Recipient

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

has assigned to distinguish your account.

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 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 grants you received from a federal, state, or local

government.

Box 7. Shows Department of Agriculture payments that are taxable to

you. 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 3. Identifies the tax year for which the refunds, credits, or offsets shown

in box 2 were made. If there is no entry in this box, the refund is for 2008

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 at a 28% rate if you did not give your

taxpayer identification number to the payer. See Form W-9, Request for

Taxpayer Identification Number and Certification, for information on

backup withholding. Include this amount on your income tax return as tax

withheld.

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

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

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

Form 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 amount in

excess of $2,400 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, Estimated Tax

for Individuals. If you made contributions to a governmental unemployment

compensation program and received a payment from that program, the payor

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, reduce your taxable amount (but

not below zero) by the amount of your contributions.

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

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

to report.
CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0120 1 Unemployment compensation

Certain

Government

Payments

$

State or local income tax

refunds, credits, or offsets

2

$

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 grants

$

Street address (including apt. no.) Agriculture payments

$

City, state, and ZIP code

Account number (see instructions)

Form 1099-G Department of the Treasury - Internal Revenue Service

VOID

Copy C

For Payer

Form 1099-G

5

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2009 General

Instructions for

Forms 1099,

1098, 3921, 3922,

5498, and W-2G.

8 Check if box 2 is

trade or business

income 

ATAA payments

$

7

2009

Market gain

$

9
Instructions for Payers

General and specific form instructions are provided as

separate products. The products you should use to

complete Form 1099-G are the 2009 General

Instructions for Forms 1099, 1098, 3921, 3922, 5498,

and W-2G and the 2009 Instructions for Form 1099-G.

A chart in the 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 February 1, 2010.

File Copy A of this form with the IRS by March 1,

2010. If you file electronically, the due date is 

March 31, 2010. To file electronically, you must have

software that generates a file according to the

specifications in Pub. 1220, Specifications for Filing

Forms 1098, 1099, 3921, 3922, 5498, and W-2G

Electronically. IRS does not provide a fill-in form

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 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). For TTY/TDD equipment,

call 304-267-3367 (not toll free).