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 or 1 Total amount required to be OMB No. 1545-2284
foreign postal code, and telephone no.                                           paid
                                                                               $                             Form 1098-F           Fines, Penalties, and 
                                                                               2 Restitution/remediation     (Rev. December 2019)      Other Amounts
                                                                                  amount                     For calendar year     
                                                                               $                                  20
FILER’S TIN                         PAYER’S TIN                                3 Compliance amount           4 Date of order/agreement Copy A
                                                                               $                                                               For 
PAYER’S name                                                                   5 Jurisdiction                                          Internal Revenue 
                                                                                                                                       Service Center
                                                                               6 Case number                                           File with Form 1096.
Street address (including apt. no.)                                                                                                    For Privacy Act and 
                                                                               7 Name or description of matter/suit/agreement          Paperwork Reduction 
City or town, state or province, country, and ZIP or foreign postal code                                                               Act Notice, see the 
                                                                                                                                       current General 
                                                                               8 Code                                                  Instructions for 
                                                                                                                                       Certain Information 
                                                                                                                                       Returns.
Form 1098-F (Rev. 12-2019)             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 or 1 Total amount required to be OMB No. 1545-2284
foreign postal code, and telephone no.                                           paid
                                                                               $                             Form 1098-F           Fines, Penalties, and 
                                                                               2 Restitution/remediation     (Rev. December 2019)      Other Amounts
                                                                                  amount                     For calendar year     
                                                                               $                                  20
FILER’S TIN                        PAYER’S TIN                                 3 Compliance amount           4 Date of order/agreement Copy B
                                                                               $
PAYER’S name                                                                   5 Jurisdiction                                          For Payer

                                                                               6 Case number
Street address (including apt. no.)
                                                                               7 Name or description of matter/suit/agreement          This is important tax 
                                                                                                                                       information and is 
City or town, state or province, country, and ZIP or foreign postal code                                                               being furnished to 
                                                                               8 Code                                                   the IRS.

Form 1098-F (Rev. 12-2019)             (keep for your records)                   www.irs.gov/Form1098F         Department of the Treasury - Internal Revenue Service

Instructions for Payer                                                            Box 6. Shows the case number associated with a court order or an 
This statement has been furnished to you by a government or                       agreement, if applicable.
governmental entity regarding a court order or an agreement with respect          Box 7. Provides a name or description to identify the underlying case or 
to a violation or potential violation of law. Retain this statement for your      matter to which a court order or an agreement relates.
records.                                                                          Box 8. Shows one or more of the following codes.
Payer’s taxpayer identification number (TIN). For your protection, this           A—Multiple payments.
form may show only the last four digits of your TIN (social security number       B—Multiple payers/defendants.
(SSN), individual taxpayer identification number (ITIN), adoption taxpayer 
identification number (ATIN), or employer identification number (EIN)).           C—Multiple payees.
However, the issuer has reported your complete TIN to the IRS.                    D—Property or services required to be acquired, constructed, or transferred 
Box 1. Shows the total amount required to be paid in relation to the violation or under a court order or an agreement.
potential violation of law as stated in a court order or an agreement.            E—Payment amount not identified.
Box 2. Shows the amount of restitution or remediation required to be paid         F—Paid in full as of time of filing.
as stated in a court order or an agreement.
                                                                                  G—No payment received as of time of filing.
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.          H—Deferred prosecution agreement.
Box 4. Shows the date the order was entered by the court or the                    I—Payment to third party at the direction of a government or governmental 
agreement was fully executed.                                                     entity.
Box 5. Shows the name of the court, or any other entity, that entered the         Future developments. For the latest information about developments related 
order or approved the agreement, if applicable.                                   to Form 1098-F and its instructions, such as legislation enacted after they were 
                                                                                  published, go to www.irs.gov/Form1098F.

                                              VOID           CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP or 1 Total amount required to be OMB No. 1545-2284
foreign postal code, and telephone no.                                            paid
                                                                               $                             Form 1098-F           Fines, Penalties, and 
                                                                               2 Restitution/remediation     (Rev. December 2019)      Other Amounts
                                                                                  amount                     For calendar year     
                                                                               $                                  20
FILER’S TIN                         PAYER’S TIN                                3 Compliance amount           4 Date of order/agreement Copy C
                                                                               $
PAYER’S name                                                                   5 Jurisdiction                                          For Filer

                                                                               6 Case number
Street address (including apt. no.)                                                                                                    For Privacy Act and 
                                                                                                                                       Paperwork Reduction 
                                                                               7 Name or description of matter/suit/agreement          Act Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                                                               current General 
                                                                               8 Code                                                  Instructions for 
                                                                                                                                       Certain Information 
                                                                                                                                       Returns.

Form 1098-F (Rev. 12-2019)                                   www.irs.gov/Form1098F                             Department of the Treasury - Internal Revenue Service

Instructions for Filer
To complete Form 1098-F, use:                            To file electronically, you must have software that 
                                                         generates a file according to the specifications in Pub. 
• The current General Instructions for Certain           1220. The IRS does not provide a fill-in form option for 
Information Returns, and                                 Copy A.
• 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/Form1098F.                                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 Forms 1096, 1097, 1098,      disability with access to TTY/TDD equipment can call 
1099, 3921, or 5498 that you download and print from     304-579-4827 (not toll free). 
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.