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 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.

If you have 10 or more information returns to file, you may be required to file e-file. Go to 
IRS.gov/InfoReturn for e-file options. 

If you have fewer than 10 information returns to file, we strongly encourage you to e-file. If 
you want to file them on paper, you can place an order for the official IRS information 
returns, which include a scannable Copy A for filing with the IRS and all other applicable 
copies of the form, at IRS.gov/EmployerForms. We’ll mail you the forms you request and 
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See Publications 1141,1167  , and 1179 for more information about printing these forms.

              8686                          VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensationOMB No. 1545-0120
or foreign postal code, and telephone no.
                                                                                                           Form 1099-G                         Certain 
                                                                            $
                                                                            2 State or local income tax    (Rev. March 2024)             Government 
                                                                              refunds, credits, or offsets For calendar year                   Payments
                                                                            $
PAYER’S TIN                           RECIPIENT’S TIN                       3 Box 2 amount is for tax year 4 Federal income tax withheld          Copy A
                                                                                                           $                                           For 
RECIPIENT’S name                                                            5 RTAA payments                6 Taxable grants              Internal Revenue 
                                                                            $                              $                                   Service Center
                                                                            7 Agriculture payments         8 Check if box 2 is           File with Form 1096.
                                                                                                             trade or business 
Street address (including apt. no.)                                         $                                income                            For Privacy Act 
                                                                            9 Market gain                                                      and Paperwork 
                                                                                                                                               Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code    $                                                                  Notice, see the 
                                                                            10a State 10b State identification no.11 State income tax withheld current General 
Account number (see instructions)                              2nd TIN not.                                     $                              Instructions for 
                                                                                                                                         Certain Information 
                                                                                                                $                                 Returns.
Form 1099-G (Rev. 3-2024)                   Cat. No. 14438M                  www.irs.gov/Form1099G         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

                                            VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensationOMB No. 1545-0120
or foreign postal code, and telephone no.
                                                                                                           Form 1099-G                         Certain 
                                                                            $
                                                                            2 State or local income tax     (Rev. March 2024)                  Government 
                                                                              refunds, credits, or offsets  For calendar year                  Payments
                                                                            $
PAYER’S TIN                           RECIPIENT’S TIN                       3 Box 2 amount is for tax year 4 Federal income tax withheld
                                                                                                                                                   Copy 1
                                                                                                           $
RECIPIENT’S name                                                            5 RTAA payments                6 Taxable grants                    For State Tax 
                                                                            $                              $                                   Department
                                                                            7 Agriculture payments         8 Check if box 2 is 
                                                                                                             trade or business 
Street address (including apt. no.)                                         $                                income
                                                                            9 Market gain
City or town, state or province, country, and ZIP or foreign postal code    $
                                                                            10a State 10b State identification no. 11 State income tax withheld
Account number (see instructions)                                                                               $
                                                                                                                $
Form 1099-G (Rev. 3-2024)                            www.irs.gov/Form1099G                                  Department of the Treasury - Internal Revenue Service

                                                               CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensationOMB No. 1545-0120
or foreign postal code, and telephone no.
                                                                                                           Form 1099-G                               Certain 
                                                                            $
                                                                            2 State or local income tax    (Rev. March 2024)                    Government 
                                                                              refunds, credits, or offsets For calendar year                    Payments
                                                                            $
PAYER’S TIN                           RECIPIENT’S TIN                       3 Box 2 amount is for tax year 4 Federal income tax withheld                Copy B
                                                                                                           $                                    For Recipient
RECIPIENT’S name                                                            5 RTAA payments                6 Taxable grants                     This is important tax 
                                                                            $                              $                                    information and is 
                                                                            7 Agriculture payments         8 If checked, box 2 is               being furnished to the 
                                                                                                             trade or business                  IRS. If you are required 
Street address (including apt. no.)                                         $                                income                             to file a return, a 
                                                                            9 Market gain                                                       negligence penalty or 
                                                                                                                                                other sanction may be 
City or town, state or province, country, and ZIP or foreign postal code    $                                                                   imposed on you if this 
                                                                            10a State 10b State identification no. 11 State income tax withheld income is taxable and 
                                                                                                                                                the IRS determines that 
Account number (see instructions)                                                                               $                                    it has not been 
                                                                                                                                                        reported.
                                                                                                                $
Form 1099-G (Rev. 3-2024)                (keep for your records)             www.irs.gov/Form1099G         Department of the Treasury - Internal Revenue Service

Instructions for Recipient                                                             Box 4. Shows backup withholding or withholding you requested on 
Recipient’s taxpayer identification number (TIN). For your protection, this            unemployment compensation, Commodity Credit Corporation (CCC) loans, or 
form may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN).         certain crop disaster payments. Generally, a payer must backup withhold on 
However, the issuer has reported your complete TIN to the IRS.                         certain payments if you did not give your TIN to the payer. See Form W-9 for 
Account number. May show an account or other unique number the payer has               information on backup withholding. Include this amount on your income tax 
assigned to distinguish your account.                                                  return as tax withheld.
Caution: Identity Theft (IDT). If you suspect that you are a victim of IDT, donot      Box 5. Shows reemployment trade adjustment assistance (RTAA) payments you 
report the incorrect amount shown in box 1 of Form(s) 1099-G on your tax               received. Include on the “Other income” line of Schedule 1 (Form 1040).
return. Go to www.irs.gov/idtheftunemployment for more information.                    Box 6. Shows taxable grants you received from a federal, state, or local 
Box 1. Shows the total unemployment compensation (UC) paid to you in the               government.
calendar year reported. Combine the box 1 amounts from all Forms 1099-G and            Box 7. Shows your taxable Department of Agriculture payments. If the payer 
report the total as income on the UC line of your tax return. Except as explained      shown is anyone other than the Department of Agriculture, it means the payer 
below, this is your taxable amount. If you made contributions to a governmental        has received a payment, as a nominee, that is taxable to you. This may 
UC program or to a governmental paid family leave program and received a               represent the entire agricultural subsidy payment received on your behalf by the 
payment from that program, the payer must issue a separate Form 1099-G to              nominee, or it may be your pro rata share of the original payment. See Pub. 225 
report this amount to you. If you itemize deductions, you may deduct your              and the Schedule F (Form 1040) instructions for information about where to 
contributions on Schedule A (Form 1040) as taxes paid. If you do not itemize,          report this income. Partnerships, see Form 8825 for how to report.
only include in income the amount that is in excess of your contributions.             Box 8. If this box is checked, the amount in box 2 is attributable to an income 
Box 2. Shows refunds, credits, or offsets of state or local income tax you             tax that applies exclusively to income from a trade or business and is not a tax 
received. It may be taxable to you if you deducted the state or local income tax       of general application. If taxable, report the amount in box 2 on Schedule C or F 
paid on Schedule A (Form 1040). Even if you did not receive the amount shown,          (Form 1040), as appropriate.
for example, because (a) it was credited to your state or local estimated tax, (b)     Box 9. Shows market gain on CCC loans whether repaid using cash or CCC 
it was offset against federal or state debts, (c) it was offset against other offsets, certificates. See the Schedule F (Form 1040) instructions.
or (d) you made a charitable contribution from your refund, it is still taxable if it  Boxes 10a–11. State income tax withheld reporting boxes.
was deducted. If you received interest on this amount, you may receive Form            Future developments. For the latest information about developments related to 
1099-INT for the interest. However, the payer may include interest of less than        Form 1099-G and its instructions, such as legislation enacted after they were 
$600 in the blank box next to box 9 on Form 1099-G. Regardless of whether the          published, go to www.irs.gov/Form1099G.
interest is reported to you, report it as interest income on your tax return. See      Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost 
your tax return instructions.                                                          online federal tax preparation, e-filing, and direct deposit or payment options.
Box 3. Identifies the tax year for which the box 2 refunds, credits, or offsets 
shown were made. 

                                            VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensationOMB No. 1545-0120
or foreign postal code, and telephone no.
                                                                                                           Form 1099-G                            Certain 
                                                                            $
                                                                            2 State or local income tax     (Rev. March 2024)                  Government 
                                                                              refunds, credits, or offsets  For calendar year                  Payments
                                                                            $
PAYER’S TIN                           RECIPIENT’S TIN                       3 Box 2 amount is for tax year 4 Federal income tax withheld
                                                                                                                                                     Copy 2
                                                                                                           $
RECIPIENT’S name                                                            5 RTAA payments                6 Taxable grants                    To be filed with 
                                                                            $                              $                                   recipient’s state 
                                                                                                                                                  income tax 
                                                                            7 Agriculture payments         8 Check if box 2 is                 return, when 
                                                                                                             trade or business 
Street address (including apt. no.)                                         $                                income                                  required.
                                                                            9 Market gain
City or town, state or province, country, and ZIP or foreign postal code    $
                                                                            10a State 10b State identification no. 11 State income tax withheld
Account number (see instructions)                                                                               $
                                                                                                                $
Form 1099-G (Rev. 3-2024)                            www.irs.gov/Form1099G                                  Department of the Treasury - Internal Revenue Service