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 

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

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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 1098-F

(Rev. December 2019)

Cat. No. 71382B

Fines, Penalties, and 

Other Amounts

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-2284

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current General

Instructions for

Certain Information

Returns.

0303

For calendar year 

20

VOID CORRECTED

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

foreign postal code, and telephone no.

FILER’S TIN PAYER’S TIN

PAYER’S name

Street address (including apt. no.)

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

1 Total amount required to be 

paid

$

2 Restitution/remediation

 amount

$

3 Compliance amount

$

4 Date of order/agreement

5 Jurisdiction

6 Case number

7 Name or description of matter/suit/agreement

8 Code

Form 1098-F (Rev. 12-2019) www.irs.gov/Form1098F

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

Form 1098-F

(Rev. December 2019)

Fines, Penalties, and 

Other Amounts

Copy B

For Payer

Department of the Treasury - Internal Revenue Service

OMB No. 1545-2284

This is important tax 

information and is 

being furnished to 

 the IRS.

For calendar year 

20

CORRECTED

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

foreign postal code, and telephone no.

FILER’S TIN PAYER’S TIN

PAYER’S name

Street address (including apt. no.)

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

1 Total amount required to be 

paid

$

2 Restitution/remediation

 amount 

$

3 Compliance amount

$

4 Date of order/agreement

5 Jurisdiction

6 Case number

7 Name or description of matter/suit/agreement

8 Code

Form 1098-F (Rev. 12-2019) (keep for your records) www.irs.gov/Form1098F
Instructions for Payer

This statement has been furnished to you by a government or 

governmental entity regarding a court order or an agreement with respect 

to a violation or potential violation of law. Retain this statement for your 

records.

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

form may show only the last four digits of your TIN (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 TIN to the IRS.

Box 1. Shows the total amount required to be paid in relation to the violation or 

potential violation of law as stated in a court order or an agreement.

Box 2. Shows the amount of restitution or remediation required to be paid 

as stated in a court order or an agreement.

Box 3. Shows the amount identified in a court order or an agreement as 

required to be paid for purposes of coming into compliance with any law.

Box 4. Shows the date the order was entered by the court or the 

agreement was fully executed.

Box 5. Shows the name of the court, or any other entity, that entered the 

order or approved the agreement, if applicable.

Box 6. Shows the case number associated with a court order or an 

agreement, if applicable.

Box 7. Provides a name or description to identify the underlying case or 

matter to which a court order or an agreement relates.

Box 8. Shows one or more of the following codes.

A—Multiple payments.

B—Multiple payers/defendants.

C—Multiple payees.

D—Property or services required to be acquired, constructed, or transferred 

under a court order or an agreement.

E—Payment amount not identified.

F—Paid in full as of time of filing.

G—No payment received as of time of filing.

H—Deferred prosecution agreement.

 I—Payment to third party at the direction of a government or governmental 

entity.

Future developments. For the latest information about developments related 

to Form 1098-F and its instructions, such as legislation enacted after they were 

published, go to www.irs.gov/Form1098F.
 

Form 1098-F

(Rev. December 2019)

Fines, Penalties, and 

Other Amounts

Copy C

For Filer

Department of the Treasury - Internal Revenue Service

OMB No. 1545-2284

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year 

20

VOID CORRECTED

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

foreign postal code, and telephone no.

FILER’S TIN PAYER’S TIN

PAYER’S name

Street address (including apt. no.)

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

1 Total amount required to be

 paid

$

2 Restitution/remediation

 amount 

$

3 Compliance amount

$

4 Date of order/agreement

5 Jurisdiction

6 Case number

7 Name or description of matter/suit/agreement

8 Code

Form 1098-F (Rev. 12-2019) www.irs.gov/Form1098F
Instructions for Filer

To complete Form 1098-F, use: 

• The current General Instructions for Certain 

Information Returns, and

• The current Instructions for Form 1098-F.

To order these instructions and additional forms, go 

to www.irs.gov/Form1098F.

Caution: Because paper forms are scanned during

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

1099, 3921, or 5498 that you download and print from 

the IRS website.

Filing and furnishing. For filing and furnishing 

instructions, including due dates, and to request filing 

or furnishing extensions, see the current General 

Instructions for Certain Information Returns.

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 1098-F, 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).