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. |
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. January 2022) Government refunds, credits, or offsets For calendar year Payments $ 20 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. 1-2022) 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. January 2022) Government refunds, credits, or offsets For calendar year Payments $ 20 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. 1-2022) 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. January 2022) Government refunds, credits, or offsets For calendar year Payments $ 20 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. 1-2022) (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. January 2022) Government refunds, credits, or offsets For calendar year Payments $ 20 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. 1-2022) www.irs.gov/Form1099G Department of the Treasury - Internal Revenue Service |
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. January 2022) Government refunds, credits, or offsets For calendar year Payments $ 20 PAYER’S TIN RECIPIENT’S TIN 3 Box 2 amount is for tax year 4 Federal income tax withheld Copy C $ RECIPIENT’S name 5 RTAA payments 6 Taxable grants For Payer $ $ 7 Agriculture payments 8 Check if box 2 is For Privacy Act trade or business Street address (including apt. no.) $ income ▶ and Paperwork Reduction Act 9 Market gain Notice, see the City or town, state or province, country, and ZIP or foreign postal code $ current General 10a State 10b State identification no. 11 State income tax withheld Instructions for Certain Information Account number (see instructions) 2nd TIN not. $ Returns. $ Form 1099-G (Rev. 1-2022) www.irs.gov/Form1099G Department of the Treasury - Internal Revenue Service |
Instructions for Payer To complete Form 1099-G, use: Filing and furnishing. For filing and furnishing • The current General Instructions for Certain instructions, including due dates, and to request filing or Information Returns, and furnishing extensions, see the current General • The current Instructions for Form 1099-G. Instructions for Certain Information Returns. To order these instructions and additional forms, go Need help? If you have questions about reporting on to www.irs.gov/EmployerForms. Form 1099-G, call the information reporting customer 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 print from the IRS 304-579-4827 (not toll free). website. |