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 
Employer and Information Returns, and we’ll mail you the forms you request and their 
instructions, as well as any publications you may order.

Information returns may also be filed electronically using the IRS Filing Information Returns 
Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act 
Information Returns (AIR) program (visit www.IRS.gov/AIR).

See IRS Publications 1141, 1167, and 1179 for more information about printing these tax 
forms.

             0303                         VOID      CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP 1  Total amount required to be paid OMB No. 1545-2284
or foreign postal code, and telephone no.                                   $
                                                                            2  Amount to be paid for            Form 1098-F           Fines, Penalties, and 
                                                                               violation or potential violation
                                                                                                                (Rev. January 2022)        Other Amounts
                                                                            $
                                                                                                                For calendar year     
                                                                            3  Restitution/remediation             20
                                                                               amount
FILER’S TIN                         PAYER’S TIN                             $                                   5  Date of order/agreement Copy A
                                                                            4  Compliance amount                                                   For 
PAYER’S name                                                                $                                                              Internal Revenue 
                                                                            6  Court or entity                                             Service Center
Street address (including apt. no.)                                                                                                        File with Form 1096.
                                                                            7  Case number                                                 For Privacy Act and 
City or town, state or province, country, and ZIP or foreign postal code                                                                   Paperwork Reduction 
                                                                            8  Case name or names of parties to suit, order, or agreement  Act Notice, see the 
                                                                                                                                           current General 
                                                                                                                                           Instructions for 
                                                                            9  Code                                                        Certain Information 
                                                                                                                                           Returns.
Form 1098-F (Rev. 1-2022)           Cat. No. 71382B                      www.irs.gov/Form1098F                  Department of the Treasury - Internal Revenue Service
Do  Not  Cut  or  Separate  Forms  on  This  Page    —    Do  Not  Cut  or  Separate  Forms  on  This  Page

                                                           CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP 1  Total amount required to be paid OMB No. 1545-2284
or foreign postal code, and telephone no.                                   $
                                                                            2  Amount to be paid for            Form 1098-F           Fines, Penalties, and 
                                                                               violation or potential violation
                                                                                                                (Rev. January 2022)        Other Amounts
                                                                            $
                                                                                                                For calendar year     
                                                                            3  Restitution/remediation             20
                                                                               amount 
FILER’S TIN                        PAYER’S TIN                              $                                   5  Date of order/agreement Copy B
                                                                            4  Compliance amount                                           For Payer
PAYER’S name                                                                $
                                                                            6  Court or entity
Street address (including apt. no.)
                                                                            7  Case number
City or town, state or province, country, and ZIP or foreign postal code                                                                   This is important tax 
                                                                                                                                           information and is 
                                                                            8  Case name or names of parties to suit, order, or agreement  being furnished to 
                                                                                                                                           the IRS.
                                                                            9  Code

Form 1098-F (Rev. 1-2022)          (keep for your records)               www.irs.gov/Form1098F                  Department of the Treasury - Internal Revenue Service

Instructions for Payer                                                    Box 5. Shows the date the suit, order, or agreement became binding 
                                                                          under applicable law.
This statement has been furnished to you by a government,                 Box 6. Shows the name of the court, or any other entity, that entered 
governmental entity, or nongovernmental entity regarding a suit, court    the order or approved the agreement, if applicable.
order, or an agreement with respect to a violation or potential violation 
of law. Retain this statement for your records.                           Box 7. Shows the case number associated with the order or an 
Payer’s taxpayer identification number (TIN). For your protection,        agreement, if applicable.
this form may show only the last four digits of your TIN (social security Box 8. Provides a case name or names of the parties to the suit, 
number (SSN), individual taxpayer identification number (ITIN),           order, or agreement.
adoption taxpayer identification number (ATIN), or employer               Box 9. Code.
identification number (EIN)). However, the issuer has reported your       A—Multiple payments.
complete TIN to the IRS.
Box 1. Shows the aggregate amount required to be paid under the           B—Multiple payers.
suit, order, or agreement if the amount equals or exceeds $50,000.        C—Multiple payees.
Box 2. Shows the total amount required to be paid in relation to the      D—Provision of services or provision of property required.
violation or potential violation of law as stated in the suit, order, or  E—Payment amount not identified.
agreement. 
                                                                          Future developments. For the latest information about developments 
Box 3. Shows the amount identified in the suit, order, or agreement to    related to Form 1098-F and its instructions, such as legislation 
be paid as restitution or remediation.                                    enacted after they were published, go to www.irs.gov/Form1098F.
Box 4. Shows the amount identified in the suit, order, or agreement to    Free File Program. Go to www.irs.gov/FreeFile to see if you qualify 
be paid to come into compliance with a law.                               for  no-cost online federal tax preparation, e-filing, and direct deposit 
                                                                          or payment options.

                                          VOID CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP 1  Total amount required to be paid OMB No. 1545-2284
or foreign postal code, and telephone no.                                   $
                                                                            2  Amount to be paid for            Form 1098-F           Fines, Penalties, and 
                                                                               violation or potential violation
                                                                                                                (Rev. January 2022)        Other Amounts
                                                                            $
                                                                                                                For calendar year     
                                                                            3  Restitution/remediation             20
                                                                               amount 
FILER’S TIN                        PAYER’S TIN                              $                                   5  Date of order/agreement Copy C
                                                                            4  Compliance amount                                           For Filer
PAYER’S name                                                                $
                                                                            6  Court or entity 
Street address (including apt. no.)
                                                                            7  Case number                                                 For Privacy Act and 
City or town, state or province, country, and ZIP or foreign postal code                                                                   Paperwork Reduction 
                                                                            8  Case name or names of parties to suit, order, or agreement  Act Notice, see the 
                                                                                                                                           current General 
                                                                                                                                           Instructions for 
                                                                            9  Code                                                        Certain Information 
                                                                                                                                           Returns.
Form 1098-F (Rev. 1-2022)                      www.irs.gov/Form1098F                                            Department of the Treasury - Internal Revenue Service

Instructions for Filer
To complete Form 1098-F, use:                         Filing and furnishing. For filing and furnishing 
• The current General Instructions for Certain        instructions, including due dates, and to request filing 
Information Returns, and                              or furnishing extensions, see the current General 
                                                      Instructions for Certain Information Returns.
• The current Instructions for Form 1098-F.
                                                      Need help? If you have questions about reporting on 
To order these instructions and additional forms, go  Form 1098-F, call the information reporting customer 
to www.irs.gov/EmployerForms.                         service site toll free at 866-455-7438 or 304-263-8700 
Caution: Because paper forms are scanned during       (not toll free). Persons with a hearing or speech 
processing, you cannot file certain Forms 1096, 1097, disability with access to TTY/TDD equipment can call 
1098, 1099, 3921, or 5498 that you download and print 304-579-4827 (not toll free). 
from the IRS website.