Attention: 

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

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

information about penalties.

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forms.
 

Form 1099-INT

Cat. No. 14410K

Interest 

Income

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0112

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2021 General

Instructions for

Certain 

Information

Returns.

9292 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

FATCA filing 

requirement

Account number (see instructions) 2nd TIN not.

Payer’s RTN (optional)

1 Interest income

$

2 Early withdrawal penalty

$

3 Interest on U.S. Savings Bonds and Treas. obligations

$

4 Federal income tax withheld

$

5 Investment expenses

$

6 Foreign tax paid

$

7 Foreign country or U.S. possession

8 Tax-exempt interest

$

9 Specified private activity bond 

interest

$

10 Market discount

$

11 Bond premium

$

12 Bond premium on Treasury obligations

$

13 Bond premium on tax-exempt bond

$

14 Tax-exempt and tax credit 

bond CUSIP no.

15 State 16 State identification no. 17 State tax withheld

$

$

2021

Form 1099-INT www.irs.gov/Form1099INT

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

Form 1099-INT

2021 Interest 

Income

Copy 1

For State Tax 

Department 

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0112

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

FATCA filing 

requirement

Account number (see instructions)

Payer’s RTN (optional)

1 Interest income

$

2 Early withdrawal penalty

$

3 Interest on U.S. Savings Bonds and Treas. obligations

$

4 Federal income tax withheld

$

5 Investment expenses

$

6 Foreign tax paid

$

7 Foreign country or U.S. possession

8 Tax-exempt interest

$

9 Specified private activity bond 

interest

$

10 Market discount

$

11 Bond premium

$

12 Bond premium on Treasury obligations

$

13 Bond premium on tax-exempt bond 

$

14 Tax-exempt and tax credit 

bond CUSIP no.

15 State 16 State identification no. 17 State tax withheld

$

$

Form 1099-INT www.irs.gov/Form1099INT
 

Form 1099-INT

2021 Interest 

Income

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. 1545-0112

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

FATCA filing 

requirement

Account number (see instructions)

Payer’s RTN (optional)

1 Interest income

$

2 Early withdrawal penalty

$

3 Interest on U.S. Savings Bonds and Treas. obligations

$

4 Federal income tax withheld

$

5 Investment expenses

$

6 Foreign tax paid

$

7 Foreign country or U.S. possession

8 Tax-exempt interest

$

9 Specified private activity bond 

interest

$

10 Market discount

$

11 Bond premium

$

12 Bond premium on Treasury obligations

$

13 Bond premium on tax-exempt bond

$

14 Tax-exempt and tax credit 

bond CUSIP no.

15 State 16 State identification no. 17 State tax withheld

$

$

Form 1099-INT (keep for your records) www.irs.gov/Form1099INT
Instructions for Recipient

The information provided may be different for covered and noncovered 

securities. For a description of covered securities, see the Instructions for 

Form 8949. For a taxable covered security acquired at a premium, unless you 

notified the payer in writing in accordance with Regulations section 

1.6045-1(n)(5) that you did not want to amortize the premium under section 171, 

or for a tax-exempt covered security acquired at a premium, your payer 

generally must report either (1) a net amount of interest that reflects the offset of 

the amount of interest paid to you by the amount of premium amortization 

allocable to the payment(s), or (2) a gross amount for both the interest paid to 

you and the premium amortization allocable to the payment(s). If you did notify 

your payer that you did not want to amortize the premium on a taxable covered 

security, then your payer will only report the gross amount of interest paid to 

you. For a noncovered security acquired at a premium, your payer is only 

required to report the gross amount of interest paid to you.

Recipient’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.

FATCA filing requirement. If the FATCA filing requirement box is checked, the 

payer is reporting on this Form 1099 to satisfy its chapter 4 account reporting 

requirement. You also may have a filing requirement. See the Instructions for 

Form 8938.

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

assigned to distinguish your account.

Box 1. Shows taxable interest paid to you during the calendar year by the payer. 

This does not include interest shown in box 3. May also show the total amount 

of the credits from clean renewable energy bonds, new clean renewable energy

bonds, qualified energy conservation bonds, qualified zone academy bonds,

qualified school construction bonds, and build America bonds that must be 

included in your interest income. These amounts were treated as paid to you 

during 2021 on the credit allowance dates (March 15, June 15, September 15, 

and December 15). For more information, see Form 8912. See the instructions 

above for a taxable covered security acquired at a premium.

Box 2. Shows interest or principal forfeited because of early withdrawal of time

savings. You may deduct this amount to figure your adjusted gross income on

your income tax return. See the Instructions for Forms 1040 and 1040-SR to see 

where to take the deduction.

Box 3. Shows interest on U.S. Savings Bonds, Treasury bills, Treasury bonds,

and Treasury notes. This may or may not all be taxable. See Pub. 550. This

interest is exempt from state and local income taxes. This interest is not 

included in box 1. See the instructions above for a taxable covered security 

acquired at a premium.

Box 4. Shows backup withholding. Generally, a payer must backup withhold if

you did not furnish your TIN or you did not furnish the correct TIN to the payer. 

See Form W-9. Include this amount on your income tax return as tax withheld.

Box 5. Any amount shown is your share of investment expenses of a singleclass REMIC. This amount is included in box 1. Note: This amount is not 

deductible.

Box 6. Shows foreign tax paid. You may be able to claim this tax as a deduction 

or a credit on your Form 1040 or 1040-SR. See your tax return instructions.

Box 7. Shows the country or U.S. possession to which the foreign tax was paid.

Box 8. Shows tax-exempt interest paid to you during the calendar year by the 

payer. See how to report this amount in the Instructions for Forms 1040 and 

1040-SR. This amount may be subject to backup withholding. See Box 4 above. 

See the instructions above for a tax-exempt covered security acquired at a 

premium.

Box 9. Shows tax-exempt interest subject to the alternative minimum tax. This

amount is included in box 8. See the Instructions for Form 6251. See the 

instructions above for a tax-exempt covered security acquired at a premium.

Box 10. For a taxable or tax-exempt covered security, if you made an election 

under section 1278(b) to include market discount in income as it accrues and 

you notified your payer of the election in writing in accordance with Regulations 

section 1.6045-1(n)(5), shows the market discount that accrued on the debt 

instrument during the year while held by you, unless it was reported on Form 

1099-OID. For a taxable or tax-exempt covered security acquired on or after 

January 1, 2015, accrued market discount will be calculated on a constant yield 

basis unless you notified your payer in writing in accordance with Regulations 

section 1.6045-1(n)(5) that you did not want to make a constant yield election for 

market discount under section 1276(b). Report the accrued market discount on 

your income tax return as directed in the Instructions for Forms 1040 and 

1040-SR. Market discount on a tax-exempt security is includible in taxable 

income as interest income.

(Continued on the back of Copy 2.)
 

Form 1099-INT

2021 Interest 

Income

Copy 2

To be filed with 

recipient’s state 

income tax 

return, when 

required.

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0112

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

FATCA filing 

requirement

Account number (see instructions)

Payer’s RTN (optional)

1 Interest income

$

2 Early withdrawal penalty

$

3 Interest on U.S. Savings Bonds and Treas. obligations

$

4 Federal income tax withheld

$

5 Investment expenses

$

6 Foreign tax paid

$

7 Foreign country or U.S. possession

8 Tax-exempt interest

$

9 Specified private activity bond 

interest

$

10 Market discount

$

11 Bond premium

$

12 Bond premium on Treasury obligations

$

13 Bond premium on tax-exempt bond

$

14 Tax-exempt and tax credit 

bond CUSIP no.

15 State 16 State identification no. 17 State tax withheld

$

$

Form 1099-INT www.irs.gov/Form1099INT
Instructions for Recipient (continued)

Box 11. For a taxable covered security (other than a U.S. Treasury 

obligation), shows the amount of premium amortization allocable to 

the interest payment(s), unless you notified the payer in writing in 

accordance with Regulations section 1.6045-1(n)(5) that you did not 

want to amortize bond premium under section 171. If an amount is 

reported in this box, see the Instructions for Schedule B (Form 1040) 

to determine the net amount of interest includible in income on Form 

1040 or 1040-SR with respect to the security. If an amount is not 

reported in this box for a taxable covered security acquired at a 

premium and the payer is reporting premium amortization, the payer 

has reported a net amount of interest in box 1. If the amount in box 11 

is greater than the amount of interest paid on the covered security, 

see Regulations section 1.171-2(a)(4).

Box 12. For a U.S. Treasury obligation that is a covered security, 

shows the amount of premium amortization allocable to the interest 

payment(s), unless you notified the payer in writing in accordance with 

Regulations section 1.6045-1(n)(5) that you did not want to amortize 

bond premium under section 171. If an amount is reported in this box, 

see the Instructions for Schedule B (Form 1040) to determine the net 

amount of interest includible in income on Form 1040 or 1040-SR with 

respect to the U.S. Treasury obligation. If an amount is not reported in 

this box for a U.S. Treasury obligation that is a covered security 

acquired at a premium and the payer is reporting premium 

amortization, the payer has reported a net amount of interest in box 3. 

If the amount in box 12 is greater than the amount of interest paid on 

the U.S. Treasury obligation, see Regulations section 1.171-2(a)(4).

Box 13. For a tax-exempt covered security, shows the amount of 

premium amortization allocable to the interest payment(s). If an 

amount is reported in this box, see Pub. 550 to determine the net 

amount of tax-exempt interest reportable on Form 1040 or 1040-SR. If 

an amount is not reported in this box for a tax-exempt covered 

security acquired at a premium, the payer has reported a net amount 

of interest in box 8 or 9, whichever is applicable. If the amount in box 

13 is greater than the amount of interest paid on the tax-exempt 

covered security, the excess is a nondeductible loss. See Regulations 

section 1.171-2(a)(4)(ii).

Box 14. Shows CUSIP number(s) for tax-exempt bond(s) on which 

tax-exempt interest was paid, or tax credit bond(s) on which taxable 

interest was paid or tax credit was allowed, to you during the calendar 

year. If blank, no CUSIP number was issued for the bond(s).

Boxes 15–17. State tax withheld reporting boxes. 

Nominees. If this form includes amounts belonging to another 

person(s), you are considered a nominee recipient. Complete a 

Form 1099-INT for each of the other owners showing the income 

allocable to each. File Copy A of the form with the IRS. Furnish Copy 

B to each owner. List yourself as the “payer” and the other owner(s) 

as the “recipient.” File Form(s) 1099-INT with Form 1096 with the 

Internal Revenue Service Center for your area. On Form 1096, list

yourself as the “filer.” A spouse is not required to file a nominee return 

to show amounts owned by the other spouse. 

Future developments. For the latest information about developments 

related to Form 1099-INT and its instructions, such as legislation 

enacted after they were published, go to www.irs.gov/Form1099INT.

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-INT

2021 Interest 

Income

Copy C

For Payer

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0112

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

FATCA filing 

requirement

Account number (see instructions) 2nd TIN not.

Payer’s RTN (optional)

1 Interest income

$

2 Early withdrawal penalty

$

3 Interest on U.S. Savings Bonds and Treas. obligations

$

4 Federal income tax withheld

$

5 Investment expenses

$

6 Foreign tax paid

$

7 Foreign country or U.S. possession

8 Tax-exempt interest

$

9 Specified private activity bond 

interest

$

10 Market discount

$

11 Bond premium

$

12 Bond premium on Treasury obligations

$

13 Bond premium on tax-exempt bond

$

14 Tax-exempt and tax credit 

bond CUSIP no.

15 State 16 State identification no. 17 State tax withheld

$

$

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2021 General

Instructions for

Certain 

Information

Returns.

Form 1099-INT www.irs.gov/Form1099INT
Instructions for Payer

To complete Form 1099-INT, use:

• The 2021 General Instructions for Certain Information Returns, and 

• The 2021 Instructions for Forms 1099-INT and 1099-OID.

To order these instructions and additional forms, go to 

www.irs.gov/Form1099INT.

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.

Forms 1099-INT and 1098. If you received mortgage interest in the 

course of your trade or business, you may have to report it to the 

payer of such mortgage interest and to the IRS on Form 1098, 

Mortgage Interest Statement. Do not report mortgage interest to the 

payer on Form 1099-INT. See the Instructions for Form 1098 for 

information on reporting mortgage interest.

Foreign recipient. If the recipient is a nonresident alien, you may have 

to withhold federal income tax and file Form 1042-S. See the 

Instructions for Form 1042-S and Pub. 515.

Need help? If you have questions about reporting on Form 1099-INT, 

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).