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                         Attention filers of Form 1096: 

This form is provided for informational purposes only. It appears in red, similar to the official 
IRS form. The official printed version of this IRS form is scannable, but a copy, printed from 
this website, is not. Do not print and file a Form 1096 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.

To order official IRS information returns, which include a scannable Form 1096 for filing with 
the IRS, 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. To file electronically, you must have 
software, or a service provider, that will create the file in the proper format. More information 
can be found at: 
• IRS Filing Information Returns Electronically (FIRE) system (visit www.IRS.gov/FIRE), or 
• 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.

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Do Not Staple 6969
OMB No. 1545-0108
Form 1096 Annual Summary and Transmittal of
Department of the Treasury U.S. Information Returns 2023
Internal Revenue Service
FILER’S name

Street address (including room or suite number)

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

Name of person to contact Telephone number For Official Use Only

Email address Fax number

1 Employer identification number 2 Social security number 3 Total number of forms 4 Federal income tax withheld 5 Total amount reported with this Form 1096
$ $
6 Enter an “X” in only one box below to indicate the type of form being filed.
W-2G 1097-BTC 1098 1098-C 1098-E 1098-F 1098-Q 1098-T 1099-A 1099-B 1099-C 1099-CAP 1099-DIV 1099-G 1099-INT 1099-K
32 50 81 78 84 03 74 83 80 79 85 73 91 86 92 10

1099-LS 1099-LTC 1099-MISC 1099-NEC 1099-OID 1099-PATR 1099-Q 1099-QA 1099-R 1099-S 1099-SA 1099-SB 3921 3922 5498 5498-ESA 5498-QA
16 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2A

5498-SA
27

Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Send this form, with the copies of the form checked in box 6, to the IRS in a flat mailer (not folded).
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.

Signature Title Date
Instructions When to file. If any date shown falls on a Saturday, Sunday, or legal
holiday in the District of Columbia or where the return is to be filed,
Future developments. For the latest information about developments the due date is the next business day. File Form 1096 in the calendar
related to Form 1096, such as legislation enacted after it was published, go year following the year for which the information is being reported, as
to www.irs.gov/Form1096. follows.
Reminder. You may be required to electronically file (e-file) information • With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February 28.*
returns. Go to www.irs.gov/inforeturn for e-file options. Also, see part F in • With Forms 1099-NEC, file by January 31.
the 2023 General Instructions for Certain Information Returns. • With Forms 5498, file by May 31.
Purpose of form. Use this form to transmit paper Forms 1097, 1098, * Leap years do not impact the due date. See Announcement 91-179,
1099, 3921, 3922, 5498, and W-2G to the IRS. 1991-49 I.R.B. 78, for more information.
Caution: Form 5498-QA can be filed on paper only, regardless of the Where To File
number of returns. Send all information returns filed on paper with Form 1096 to the following.
Who must file. Any person or entity who files any form checked in box 6
above must file Form 1096 to transmit those forms to the IRS. If your principal business, office or Use the following
agency, or legal residence in the
Caution: Your name and taxpayer identification number (TIN) (employer case of an individual, is located in: address:
identification number (EIN) or social security number (SSN)) must match the
name and TIN used on your 94X series tax return(s) or you may be subject Alabama, Arizona, Arkansas, Delaware,
to information return penalties. Do not use the name and/or TIN of your Florida, Georgia, Kentucky, Maine, Internal Revenue Service
paying agent or service bureau. Massachusetts, Mississippi, New P.O. Box 149213
Enter the filer’s name, address (including room, suite, or other unit Hampshire, New Jersey, New Mexico, Austin, TX 78714-9213
number), and TIN in the spaces provided on the form. The name, address, New York, North Carolina, Ohio, Texas,
and TIN of the filer on this form must be the same as those you enter in the Vermont, Virginia
upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. Alaska, Colorado, Hawaii, Idaho,
Illinois, Indiana, Iowa, Kansas,
Michigan, Minnesota, Missouri, Internal Revenue Service Center
Montana, Nebraska, Nevada, North P.O. Box 219256
Dakota, Oklahoma, Oregon, South Kansas City, MO 64121-9256
Carolina, South Dakota, Tennessee,
Utah, Washington, Wisconsin, Wyoming

For more information and the Privacy Act and Paperwork Reduction Act Notice, Cat. No. 14400O Form 1096 (2023)
see the 2023 General Instructions for Certain Information Returns.

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Form 1096 (2023) Page 2

California, Connecticut, Form 1098-Q Box 4
District of Columbia, Louisiana, Internal Revenue Service Center Form 1099-B Boxes 1d and 13
Maryland, Pennsylvania, 1973 North Rulon White Blvd.
Rhode Island, West Virginia Ogden, UT 84201 Form 1099-C Box 2
Form 1099-CAP Box 2
If your legal residence or principal place of business is outside the United Form 1099-DIV Boxes 1a, 2a, 3, 9, 10, and 12
States, file with the Internal Revenue Service, P.O. Box 149213, Austin, TX Form 1099-INT Boxes 1, 3, 8, 10, 11, and 13
78714-9213.
Form 1099-K Box 1a
Transmitting to the IRS. Group the forms by form number and transmit
each group with a separate Form 1096. For example, if you must file both Form 1099-LS Box 1
Forms 1098 and 1099-A, complete one Form 1096 to transmit your Forms Form 1099-LTC Boxes 1 and 2
1098 and another Form 1096 to transmit your Forms 1099-A. Do not send a Form 1099-MISC Boxes 1, 2, 3, 5, 6, 8, 9, 10, 11, and 14
form (1099, 5498, etc.) containing summary (subtotal) information with Form
1096. Summary information for the group of forms being sent is entered only Form 1099-NEC Box 1
in boxes 3, 4, and 5 of Form 1096. Form 1099-OID Boxes 1, 2, 5, 6, and 8
Corrected returns. Originals and corrections of the same type of return can Form 1099-PATR Boxes 1, 2, 3, and 5
be submitted using one Form 1096. For information about filing corrections, Form 1099-Q Box 1
see the 2023 General Instructions for Certain Information Returns.
Form 1099-QA Box 1
Box 1 or 2. Enter your TIN in either box 1 or 2, not both. Sole proprietors and Form 1099-R Box 1
all others must enter their EIN in box 1. Individuals not in a trade or business
must enter their SSN in box 2. However, sole proprietors who do not have an Form 1099-S Box 2
EIN must enter their SSN in box 2. Use the same EIN or SSN on Form 1096 Form 1099-SA Box 1
that you use on Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. Form 1099-SB Boxes 1 and 2
Box 3. Enter the number of forms you are transmitting with this Form 1096. Form 3921 Boxes 3 and 4
Do not include blank or voided forms or the Form 1096 in your total. Enter
the number of correctly completed forms, not the number of pages, being Form 3922 Boxes 3, 4, and 5
transmitted. For example, if you send one page of three-to-a-page Forms Form 5498 Boxes 1, 2, 3, 4, 5, 8, 9, 10, 12b, 13a, and 14a
1098-E with a Form 1096 and you have correctly completed two Forms Form 5498-ESA Boxes 1 and 2
1098-E on that page, enter “2” in box 3 of Form 1096.
Box 4. Enter the total federal income tax withheld shown on the forms being Form 5498-QA Boxes 1 and 2
transmitted with this Form 1096. Form 5498-SA Box 1
Box 5. No entry is required if you are filing Form 1098-T, 1099-A, or 1099-G. Online fillable forms. Forms 1097-BTC, 1098-C, 1098-MA, 1098-Q,
For all other forms in the listing that follows, enter the total of the amounts 1099-CAP, 1099-LTC, 1099-Q, 1099-QA, 1099-SA, 3922, 5498-ESA, and
from the specific boxes identified for each form. 5498-SA have been converted to online fillable PDFs. For more
information, see Online fillable forms in the 2023 General Instructions for
Form W-2G Box 1 Certain Information Returns.
Form 1097-BTC Box 1
Form 1098 Boxes 1 and 6
Form 1098-C Box 4c
Form 1098-E Box 1
Form 1098-F Box 1

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