PDF document
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                                    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.



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              9292                       VOID            CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Payer’s RTN (optional)                     OMB No. 1545-0112
or foreign postal code, and telephone no.
                                                                                                                       Form 1099-INT                          Interest 
                                                                            1 Interest income                          (Rev. January 2022)
                                                                                                                                                              Income
                                                                                                                       For calendar year
                                                                            $                                                     20
                                                                            2 Early withdrawal penalty
                                                                                                                                                              Copy A
PAYER’S TIN                         RECIPIENT’S TIN                         $
                                                                            3 Interest on U.S. Savings Bonds and Treasury obligations                         For 
                                                                                                                                                           Internal Revenue 
                                                                                                                                                              Service Center
                                                                            $
RECIPIENT’S name                                                            4 Federal income tax withheld           5 Investment expenses                   File with Form 1096.
                                                                            $                                       $
                                                                            6 Foreign tax paid                      7 Foreign country or U.S. possession
                                                                                                                                                            For Privacy Act 
Street address (including apt. no.)                                         $                                                                               and Paperwork 
                                                                            8 Tax-exempt interest                   9  Specified private activity bond        Reduction Act 
                                                                                                                       interest
                                                                                                                                                            Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code    $                                       $                                      current General 
                                                                            10 Market discount                      11 Bond premium                        Instructions for 
                                                                                                                                                              Certain 
                                                         FATCA filing       $                                       $                                         Information 
                                                         requirement        12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond        Returns.
                                                                            $                                       $
Account number (see instructions)                        2nd TIN not.       14 Tax-exempt and tax credit            15 State   16 State identification no. 17 State tax withheld
                                                                               bond CUSIP no.
                                                                                                                                                           $
                                                                                                                                                           $
Form 1099-INT (Rev. 1-2022)              Cat. No. 14410K                    www.irs.gov/Form1099INT                   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



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                                         VOID       CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Payer’s RTN (optional)                     OMB No. 1545-0112
or foreign postal code, and telephone no.
                                                                                                                       Form 1099-INT                          Interest 
                                                                            1 Interest income                          (Rev. January 2022)
                                                                                                                                                              Income
                                                                                                                       For calendar year
                                                                            $                                                  20
                                                                            2 Early withdrawal penalty
                                                                                                                                                              Copy 1
PAYER’S TIN                         RECIPIENT’S TIN                         $
                                                                            3 Interest on U.S. Savings Bonds and Treasury obligations                         For State Tax 
                                                                                                                                                              Department 
                                                                            $                                                                                                    
RECIPIENT’S name                                                            4 Federal income tax withheld           5 Investment expenses
                                                                            $                                       $
                                                                            6 Foreign tax paid                      7 Foreign country or U.S. possession
Street address (including apt. no.)                                         $
                                                                            8 Tax-exempt interest                   9  Specified private activity bond 
                                                                                                                       interest
City or town, state or province, country, and ZIP or foreign postal code    $                                       $
                                                                            10 Market discount                      11 Bond premium

                                                    FATCA filing            $                                       $
                                                    requirement             12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond 
                                                                            $                                       $
Account number (see instructions)                                           14 Tax-exempt and tax credit            15 State   16 State identification no. 17 State tax withheld
                                                                               bond CUSIP no.
                                                                                                                                                           $
                                                                                                                                                           $
Form 1099-INT (Rev. 1-2022)                                                 www.irs.gov/Form1099INT                   Department of the Treasury - Internal Revenue Service



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                                                    CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP Payer’s RTN (optional)                     OMB No. 1545-0112
or foreign postal code, and telephone no.
                                                                                                                       Form 1099-INT                        Interest 
                                                                            1 Interest income                          (Rev. January 2022)
                                                                                                                                                            Income
                                                                                                                       For calendar year
                                                                            $                                                   20
                                                                            2 Early withdrawal penalty
                                                                                                                                                            Copy B
PAYER’S TIN                         RECIPIENT’S TIN                         $
                                                                                                                                                            For Recipient
                                                                            3 Interest on U.S. Savings Bonds and Treasury obligations

                                                                            $
RECIPIENT’S name                                                            4 Federal income tax withheld           5 Investment expenses                This is important tax 
                                                                            $                                       $                                       information and is 
                                                                                                                                                         being furnished to the 
                                                                            6 Foreign tax paid                      7 Foreign country or U.S. possession    IRS. If you are 
Street address (including apt. no.)                                         $                                                                               required to file a 
                                                                            8 Tax-exempt interest                   9  Specified private activity bond    return, a negligence 
                                                                                                                       interest                             penalty or other 
                                                                                                                                                            sanction may be 
City or town, state or province, country, and ZIP or foreign postal code    $                                       $                                      imposed on you if 
                                                                            10 Market discount                      11 Bond premium                         this income is 
                                                                                                                                                          taxable and the IRS 
                                                                                                                                                         determines that it has 
                                                    FATCA filing            $                                       $                                     not been reported.
                                                    requirement             12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
                                                                            $                                       $
Account number (see instructions)                                           14 Tax-exempt and tax credit            15 State 16 State identification no. 17 State tax withheld
                                                                               bond CUSIP no.
                                                                                                                                                         $
                                                                                                                                                         $
Form 1099-INT (Rev. 1-2022)         (keep for your records)                 www.irs.gov/Form1099INT                   Department of the Treasury - Internal Revenue Service



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Instructions for Recipient
The information provided may be different for covered and noncovered                 Box 3. Shows interest on U.S. Savings Bonds, Treasury bills, Treasury bonds, 
securities. For a description of covered securities, see the Instructions for        and Treasury notes. This may or may not all be taxable. See Pub. 550. This 
Form 8949. For a taxable covered security acquired at a premium, unless you          interest is exempt from state and local income taxes. This interest is not 
notified the payer in writing in accordance with Regulations section                 included in box 1. See the instructions above for a taxable covered security 
1.6045-1(n)(5) that you did not want to amortize the premium under section 171,      acquired at a premium.
or for a tax-exempt covered security acquired at a premium, your payer must          Box 4. Shows backup withholding. Generally, a payer must backup withhold if 
generally report either (1) a net amount of interest that reflects the offset of the you did not furnish your TIN or you did not furnish the correct TIN to the payer. 
amount of interest paid to you by the amount of premium amortization allocable       See Form W-9. Include this amount on your income tax return as tax withheld. 
to the payment(s), or (2) a gross amount for both the interest paid to you and the   Box 5. Any amount shown is your share of investment expenses of a single-
premium amortization allocable to the payment(s). If you did notify your payer       class REMIC. This amount is included in box 1. Note: This amount is not 
that you did not want to amortize the premium on a taxable covered security,         deductible.
then your payer will only report the gross amount of interest paid to you. For a     Box 6. Shows foreign tax paid. You may be able to claim this tax as a deduction 
noncovered security acquired at a premium, your payer is only required to report     or a credit on your Form 1040 or 1040-SR. See your tax return instructions.
the gross amount of interest paid to you.
Recipient’s taxpayer identification number (TIN). For your protection, this          Box 7. Shows the country or U.S. possession to which the foreign tax was paid.
form may show only the last four digits of your TIN (social security number          Box 8. Shows tax-exempt interest paid to you during the calendar year by the 
(SSN), individual taxpayer identification number (ITIN), adoption taxpayer           payer. See how to report this amount in the Instructions for Form 1040. This 
identification number (ATIN), or employer identification number (EIN)). However,     amount may be subject to backup withholding. See Box 4 above. See the 
the issuer has reported your complete TIN to the IRS.                                instructions above for a tax-exempt covered security acquired at a premium.
FATCA filing requirement. If the FATCA filing requirement box is checked, the        Box 9. Shows tax-exempt interest subject to the alternative minimum tax. This 
payer is reporting on this Form 1099 to satisfy its chapter 4 account reporting      amount is included in box 8. See the Instructions for Form 6251. See the 
requirement. You may also have a filing requirement. See the Instructions for        instructions above for a tax-exempt covered security acquired at a premium.
Form 8938.                                                                           Box 10. For a taxable or tax-exempt covered security, if you made an election 
Account number. May show an account or other unique number the payer                 under section 1278(b) to include market discount in income as it accrues and 
assigned to distinguish your account.                                                you notified your payer of the election in writing in accordance with Regulations 
Box 1.Shows taxable interest paid to you during the calendar year by the payer.      section 1.6045-1(n)(5), shows the market discount that accrued on the debt 
This does not include interest shown in box 3. May also show the total amount        instrument during the year while held by you, unless it was reported on Form 
of the credits from clean renewable energy bonds, new clean renewable energy         1099-OID. For a taxable or tax-exempt covered security acquired on or after 
bonds, qualified energy conservation bonds, qualified zone academy bonds,            January 1, 2015, accrued market discount will be calculated on a constant yield 
qualified school construction bonds, and build America bonds that must be            basis unless you notified your payer in writing in accordance with Regulations 
included in your interest income. These amounts were treated as paid to you          section 1.6045-1(n)(5) that you did not want to make a constant yield election for 
during the calendar year on the credit allowance dates (March 15, June 15,           market discount under section 1276(b). Report the accrued market discount on 
September 15, and December 15). For more information, see Form 8912. See             your income tax return as directed in the Instructions for Form 1040. Market 
the instructions above for a taxable covered security acquired at a premium.         discount on a tax-exempt security is includible in taxable income as interest 
Box 2. Shows interest or principal forfeited because of early withdrawal of time     income.
savings. You may deduct this amount to figure your adjusted gross income on 
your income tax return. See the Instructions for Form 1040 to see where to take                                               (Continued on the back of Copy 2.)
the deduction.



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                                                    CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP Payer’s RTN (optional)                     OMB No. 1545-0112
or foreign postal code, and telephone no.
                                                                                                                       Form 1099-INT                          Interest 
                                                                            1 Interest income                          (Rev. January 2022)
                                                                                                                                                              Income
                                                                                                                       For calendar year
                                                                            $                                                  20
                                                                            2 Early withdrawal penalty
                                                                                                                                                              Copy 2
PAYER’S TIN                         RECIPIENT’S TIN                         $
                                                                            3 Interest on U.S. Savings Bonds and Treasury obligations

                                                                            $
RECIPIENT’S name                                                            4 Federal income tax withheld           5 Investment expenses
                                                                            $                                       $
                                                                            6 Foreign tax paid                      7 Foreign country or U.S. possession    To be filed with 
Street address (including apt. no.)                                         $                                                                               recipient’s state 
                                                                                                                                                              income tax 
                                                                            8 Tax-exempt interest                   9  Specified private activity bond        return, when 
                                                                                                                       interest
                                                                                                                                                              required.
City or town, state or province, country, and ZIP or foreign postal code    $                                       $
                                                                            10 Market discount                      11 Bond premium

                                                    FATCA filing            $                                       $
                                                    requirement             12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
                                                                            $                                       $
Account number (see instructions)                                           14 Tax-exempt and tax credit            15 State   16 State identification no. 17 State tax withheld
                                                                               bond CUSIP no.
                                                                                                                                                           $
                                                                                                                                                           $
Form 1099-INT (Rev. 1-2022)                                                 www.irs.gov/Form1099INT                   Department of the Treasury - Internal Revenue Service



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Instructions for Recipient (continued)
Box 11. For a taxable covered security (other than a U.S. Treasury       Box 13. For a tax-exempt covered security, shows the amount of 
obligation), shows the amount of premium amortization allocable to       premium amortization allocable to the interest payment(s). If an 
the interest payment(s), unless you notified the payer in writing in     amount is reported in this box, see Pub. 550 to determine the net   
accordance with Regulations section 1.6045-1(n)(5) that you did not      amount of tax-exempt interest reportable on Form 1040 or 1040-SR. 
want to amortize bond premium under section 171. If an amount is         If an amount is not reported in this box for a tax-exempt covered 
reported in this box, see the Instructions for Schedule B (Form 1040)    security acquired at a premium, the payer has reported a net amount 
to determine the net amount of interest includible in income on Form     of interest in box 8 or 9, whichever is applicable. If the amount in box 
1040 or 1040-SR with respect to the security. If an amount is not        13 is greater than the amount of interest paid on the tax-exempt 
reported in this box for a taxable covered security acquired at a        covered security, the excess is a nondeductible loss. See Regulations 
premium and the payer is reporting premium amortization, the payer       section 1.171-2(a)(4)(ii).
has reported a net amount of interest in box 1. If the amount in box 11  Box 14. Shows CUSIP number(s) for tax-exempt bond(s) on which 
is greater than the amount of interest paid on the covered security,     tax-exempt interest was paid, or tax credit bond(s) on which taxable 
see Regulations section 1.171-2(a)(4).                                   interest was paid or tax credit was allowed, to you during the calendar 
Box 12. For a U.S. Treasury obligation that is a covered security,       year. If blank, no CUSIP number was issued for the bond(s).
shows the amount of premium amortization allocable to the interest       Boxes 15–17. State tax withheld reporting boxes. 
payment(s), unless you notified the payer in writing in accordance with  Nominees. If this form includes amounts belonging to another   
Regulations section 1.6045-1(n)(5) that you did not want to amortize     person(s), you are considered a nominee recipient. Complete a     
bond premium under section 171. If an amount is reported in this box,    Form 1099-INT for each of the other owners showing the income 
see the Instructions for Schedule B (Form 1040) to determine the net     allocable to each. File Copy A of the form with the IRS. Furnish Copy 
amount of interest includible in income on Form 1040 or 1040-SR with     B to each owner. List yourself as the “payer” and the other owner(s) 
respect to the U.S. Treasury obligation. If an amount is not reported in as the “recipient.” File Form(s) 1099-INT with Form 1096 with the 
this box for a U.S. Treasury obligation that is a covered security       Internal Revenue Service Center for your area. On Form 1096, list 
acquired at a premium and the payer is reporting premium                 yourself as the “filer.” A spouse is not required to file a nominee return 
amortization, the payer has reported a net amount of interest in box 3.  to show amounts owned by the other spouse. 
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).     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.
                                                                         Free File Program. 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.



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                                         VOID       CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Payer’s RTN (optional)                     OMB No. 1545-0112
or foreign postal code, and telephone no.
                                                                                                                       Form 1099-INT                        Interest 
                                                                            1 Interest income                          (Rev. January 2022)
                                                                                                                                                            Income
                                                                                                                       For calendar year
                                                                            $                                                   20
                                                                            2 Early withdrawal penalty
                                                                                                                                                            Copy C
PAYER’S TIN                         RECIPIENT’S TIN                         $
                                                                            3 Interest on U.S. Savings Bonds and Treasury obligations
                                                                                                                                                            For Payer
                                                                            $
RECIPIENT’S name                                                            4 Federal income tax withheld           5 Investment expenses
                                                                            $                                       $
                                                                            6 Foreign tax paid                      7 Foreign country or U.S. possession  For Privacy Act 
Street address (including apt. no.)                                         $                                                                             and Paperwork 
                                                                            8 Tax-exempt interest                   9  Specified private activity bond      Reduction Act 
                                                                                                                       interest                           Notice, see the 
                                                                                                                                                         current General 
City or town, state or province, country, and ZIP or foreign postal code    $                                       $                                    Instructions for 
                                                                            10 Market discount                      11 Bond premium
                                                                                                                                                            Certain 
                                                                                                                                                            Information 
                                                    FATCA filing            $                                       $                                       Returns.
                                                    requirement             12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
                                                                            $                                       $
Account number (see instructions)                   2nd TIN not.            14 Tax-exempt and tax credit            15 State 16 State identification no. 17 State tax withheld
                                                                               bond CUSIP no.
                                                                                                                                                         $
                                                                                                                                                         $
Form 1099-INT (Rev. 1-2022)                                                 www.irs.gov/Form1099INT                   Department of the Treasury - Internal Revenue Service



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Instructions for Payer
To complete Form 1099-INT, use:                                         Forms 1099-INT and 1098. If you received mortgage interest in the 
• The current General Instructions for Certain Information Returns, and 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, 
• The current Instructions for Forms 1099-INT and 1099-OID.             Mortgage Interest Statement. Do not report mortgage interest to the 
  To order these instructions and additional forms, go to               payer on Form 1099-INT. See the Instructions for Form 1098 for 
www.irs.gov/EmployerForms.                                              information on reporting mortgage interest.
Caution: Because paper forms are scanned during processing, you         Foreign recipient. If the recipient is a nonresident alien, you may 
cannot file certain Forms 1096, 1097, 1098, 1099, 3921, or 5498 that    have to withhold federal income tax and file Form 1042-S. See the 
you print from the IRS website.                                         Instructions for Form 1042-S and Pub. 515.
Filing and furnishing.For filing and furnishing instructions, including Need help? If you have questions about reporting on Form 1099-INT, 
due dates, and to request filing or furnishing extensions, see the      call the information reporting customer service site toll free at 
current General Instructions for Certain Information Returns.           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). 






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