Attention: 

This form is provided for informational purposes only. Copy A appears in red, similar to the 

official IRS form. Do not file copy A downloaded from this website. The official printed 

version of this IRS form is scannable, but the online version of it, printed from this website, 

is not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the 

current General Instructions for Certain Information Returns for more information about 

penalties. 

To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order Information 

Returns and Employer Returns Online, and we’ll mail you the scannable forms and other 

products. 

See IRS Publications 1141, 1167, 1179 and other IRS resources for information about 

printing these tax forms. 
 

Form 3922

(Rev. August 2013)

Cat. No. 41180P

Transfer of Stock 

Acquired Through 

an Employee 

Stock Purchase 

Plan Under 

Section 423(c)

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-2129

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current version of the

General Instructions for

Certain Information

Returns.

2626 VOID CORRECTED

CORPORATION'S name, street address, city or town, state or province, 

country, and ZIP or foreign postal code

CORPORATION'S federal identification number EMPLOYEE’S identification number

EMPLOYEE’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 Date option granted

2 Date option exercised

3 Fair market value per share 

on grant date

$

4 Fair market value per share 

on exercise date

$

5 Exercise price paid per share

$

6 No. of shares transferred

7 Date legal title transferred

8 Exercise price per share determined as if the option was 

exercised on the date shown in box 1.

$

Form 3922 (Rev. 8-2013) www.irs.gov/form3922

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

Form 3922

(Rev. August 2013)

Transfer of Stock 

Acquired Through 

an Employee 

Stock Purchase 

Plan Under 

Section 423(c)

Copy B

For Employee

Department of the Treasury - Internal Revenue Service

This is important tax 

information and is 

being furnished to 

the Internal Revenue 

Service.

OMB No. 1545-2129

CORRECTED

CORPORATION'S name, street address, city or town, state or province, 

country, and ZIP or foreign postal code

CORPORATION'S federal identification number EMPLOYEE’S identification number

EMPLOYEE’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 Date option granted

2 Date option exercised

3 Fair market value per share 

on grant date

$

4 Fair market value per share 

on exercise date

$

5 Exercise price paid per share

$

6 No. of shares transferred

7 Date legal title transferred

8 Exercise price per share determined as if the option was 

exercised on the date shown in box 1.

$

Form 3922 (Rev. 8-2013) (keep for your records) www.irs.gov/form3922
Instructions for Employee

You have received this form because (1) your employer (or its 

transfer agent) has recorded a first transfer of legal title of 

stock you acquired pursuant to your exercise of an option 

granted under an employee stock purchase plan and (2) the 

exercise price was less than 100 percent of the value of the 

stock on the date shown in box 1 or was not fixed or 

determinable on that date.

No income is recognized when you exercise an option 

under an employee stock purchase plan. However, you must 

recognize (report) gain or loss on your tax return for the year in 

which you sell or otherwise dispose of the stock. Keep this 

form and use it to figure the gain or loss. For more information, 

see Pub. 525, Taxable and Nontaxable Income.

Account number. May show an account or other unique 

number your employer or transfer agent assigned to 

distinguish your account.

Box 1. Shows the date the option to purchase the stock was 

granted to you.

Box 2. Shows the date you exercised the option to purchase 

the stock.

Box 3. Shows the fair market value (FMV) per share on the 

date the option to purchase the stock was granted to you.

Box 4. Shows the FMV per share on the date you exercised 

the option to purchase the stock.

Box 5. Shows the price paid per share on the date you

exercised the option to purchase the stock.

Box 6. Shows the number of shares to which legal title was 

transferred by you.

Box 7. Shows the date legal title of the shares was first 

transferred by you.

Box 8. If the exercise price per share was not fixed or

determinable on the date entered in box 1, box 8 shows the 

exercise price per share determined as if the option was 

exercised on the date in box 1. If the exercise price per share 

was fixed or determinable on the date shown in box 1, then 

box 8 will be blank.

Future developments. For the latest information about 

developments related to Form 3922 and its instructions, such 

as legislation enacted after they were published, go to

www.irs.gov/form3922.
 

Form 3922

(Rev. August 2013)

Transfer of Stock 

Acquired Through 

an Employee 

Stock Purchase 

Plan Under 

Section 423(c)

Copy C

For Corporation

Department of the Treasury - Internal Revenue Service

This copy should be 

retained by the 

corporation.

OMB No. 1545-2129

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current version of the

General Instructions 

for Certain 

Information Returns.

VOID CORRECTED

CORPORATION'S name, street address, city or town, state or province, 

country, and ZIP or foreign postal code

CORPORATION'S federal identification number EMPLOYEE’S identification number

EMPLOYEE’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 Date option granted

2 Date option exercised

3 Fair market value per share 

on grant date

$

4 Fair market value per share 

on exercise date

$

5 Exercise price paid per share

$

6 No. of shares transferred

7 Date legal title transferred

8 Exercise price per share determined as if the option was 

exercised on the date shown in box 1.

$

Form 3922 (Rev. 8-2013) www.irs.gov/form3922
Instructions for Corporation

To complete Form 3922, use:

• the current General Instructions for Certain 

Information Returns, and

• the current Instructions for Forms 3921 and 3922.

To order these instructions and additional forms, go 

to www.irs.gov/form3922 or call 1-800-TAX-FORM 

(1-800-829-3676).

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 employee 

by January 31 of the year following the year of first 

transfer of the stock acquired through the employee 

stock purchase plan.

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

of the year following the year of first transfer of the 

stock acquired through the employee stock purchase 

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

of the year following the year of first transfer of the 

stock acquired through the employee stock purchase 

plan. To file electronically, you must have software that 

generates a file according to the specifications in Pub. 

1220, Specifications for Electronic Filing of Forms 1097, 

1098, 1099, 3921, 3922, 5498, 8935, and W-2G. The 

IRS does not provide a fill-in form option.

Need help? If you have questions about reporting on

Form 3922, 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).