3131                    VOID              CORRECTED
PAYER’S/TRUSTEE’S name, street address, city or town, state or province, 1 Gross distribution         OMB No. 1545-1760               Payments From 
country, ZIP or foreign postal code, and telephone no.
                                                                                                                                      Qualified 
                                                                         $                            Form 1099-Q                     Education 
                                                                         2 Earnings                   (Rev. November 2019)            Programs 
                                                                                                      For calendar year               (Under Sections 
                                                                                                           20                         529 and 530)
                                                                         $
PAYER’S/TRUSTEE’S TIN               RECIPIENT’S TIN                      3 Basis                      4 Trustee-to-trustee            Copy A
                                                                                                        transfer
                                                                         $                                                            For 
RECIPIENT’S name                                                         5 Distribution is from:      6 Check if the recipient is     Internal Revenue 
                                                                         • Qualified tuition program—   not the designated            Service Center
                                                                                                        beneficiary
                                                                           Private       or State                                     File with Form 1096.
Street address (including apt. no.)                                      • Coverdell ESA                                              For Privacy Act 
                                                                                                                                      and Paperwork 
                                                                                                                                      Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code                                                              Notice, see the 
                                                                                                                                      currentGeneral       
                                                                                                                                      Instructions for 
Account number (see instructions)                                                                                                     Certain Information 
                                                                                                                                      Returns.
Form 1099-Q (Rev. 11-2019)          Cat. No. 32223J                      www.irs.gov/Form1099Q          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 (if checked)
PAYER’S/TRUSTEE’S name, street address, city or town, state or province, 1 Gross distribution         OMB No. 1545-1760               Payments From 
country, ZIP or foreign postal code, and telephone no.
                                                                                                                                      Qualified 
                                                                         $                            Form 1099-Q                     Education 
                                                                         2 Earnings                   (Rev. November 2019)            Programs 
                                                                                                      For calendar year               (Under Sections 
                                                                                                           20                         529 and 530)
                                                                         $
PAYER’S/TRUSTEE’S TIN               RECIPIENT’S TIN                      3 Basis                      4 Trustee-to-trustee            Copy B
                                                                                                        transfer
                                                                         $                                                            For Recipient
RECIPIENT’S name                                                         5 Distribution is from:      6 If this box is checked, the   This is important tax 
                                                                         • Qualified tuition program—   recipient is not the          information and is 
                                                                                                        designated beneficiary        being furnished to 
                                                                           Private       or State                                     the IRS. If you are 
Street address (including apt. no.)                                      • Coverdell ESA                                              required to file a return, 
                                                                         If the fair market value (FMV) is shown below, see Pub. 970,  a negligence penalty 
                                                                         Tax Benefits for Education, for how to figure earnings.      or other sanction may 
City or town, state or province, country, and ZIP or foreign postal code                                                              be imposed on you 
                                                                                                                                       if this income is 
                                                                                                                                      taxable and the IRS 
Account number (see instructions)                                                                                                     determines that it has 
                                                                                                                                      not been reported.
Form 1099-Q (Rev. 11-2019)          (keep for your records)              www.irs.gov/Form1099Q          Department of the Treasury - Internal Revenue Service

Instructions for Recipient                                                                       Under a CESA, the amount in box 2 is included in income if there has been a 
Distributions from Coverdell education savings accounts (CESAs) under section 530                change in the designated beneficiary and the new designated beneficiary is not a 
and qualified tuition programs (QTPs) under section 529, including rollovers, may be             family member or is over age 30 (except for beneficiaries with special needs).
taxable. Nontaxable distributions from CESAs and QTPs are not required to be                     Also, an additional 10% tax may apply to part or all of any amount included in 
reported on your income tax return. You must determine the taxability of any                     income from the CESA or QTP. See Form 5329 and your tax return instructions for 
distribution. See Pub. 970 and the Instructions for Forms 1040 and 1040-SR for more              more information.
information. Also see Form 5329 and its separate instructions.                                   If a final (total) distribution is made from your account and you have not recovered 
Recipient’s taxpayer identification no. (TIN). For your protection, this form may                your contributions, see Pub. 970 to determine if you have a deductible loss and how to 
show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). However, the payer         claim it.
or trustee has reported your complete TIN to the IRS.                                            Box 3. Shows your basis in the gross distribution reported in box 1.
Account number. May show an account or other unique number the payerhas                          Box 4.This box is checked if a trustee-to-trustee transfer was made from oneQTP to 
assigned to distinguish your account.                                                            another QTP, from one CESA to another CESA, from a CESA to aQTP, or from a QTP to an 
Box 1. Shows the gross distribution (including in-kind distributions) paid to youthis            ABLE account. However, in certain transfers from a CESA, the box will be blank.
year from a QTP or aCESA. This amount is the total of theamounts   shown in boxes 2              Box 5.Shows whether the gross distribution was from a QTP (private or state)or    from 
and 3. See Pub. 970 for more information.                                                        a CESA.
Caution:For CESA distributions (other than earnings on excess contributions)made      during the Box 6.The designated beneficiary is the individual named in the document creating 
calendar year, the payer/trustee is not required to report amounts in boxes2 and 3. Instead, thethe trust or custodial account to receive the benefit of the funds in the account. If you 
payer/trustee may report the fair market value of the CESAas of December 31 of the calendar      are not the designated beneficiary, see Pub. 970 and the Instructions for Forms 1040 
year in the blank box below boxes 5 and 6. To figure  yourearnings and basis, use the Coverdelland 1040-SR.
ESA—Taxable Distributions and Basisworksheet      in Pub. 970.                                   Distribution codes. For the calendar year, the payer/trustee may, but is not required 
Box 2.Shows the earnings part of the gross distribution shown in box 1.Generally,                to,report (in the box below boxes 5 and 6) one of the following codes to identifythe 
amounts distributed that are used topay  for qualified education expenses, transferred           distribution you received: 1—Distributions (including transfers); 2—Excess 
between trustees, or rolledover to another qualified education program or to an ABLE             contributions plus earnings taxable in the calendar year; 3—Excess contributions plus 
account, within 60 days, are not included in income.                                             earnings taxable in the prior calendar year; 4—Disability; 5—Death; or 6—Prohibited 
 Under a QTP, the amount in box 2 is included in income if there has been (a) more               transaction.  
than one transfer or rollover within any 12-month period with respect to the same                Future developments. For the latest information about developments related to Form 
beneficiary, or (b) a change in the designated beneficiary and the new designated                1099-Q and its instructions, such as legislation enacted after they were published, go 
beneficiary is not a family member.                                                              to www.irs.gov/Form1099Q.

                                    VOID              CORRECTED
PAYER’S/TRUSTEE’S name, street address, city or town, state or province, 1 Gross distribution         OMB No. 1545-1760               Payments From 
country, ZIP or foreign postal code, and telephone no.
                                                                                                                                      Qualified 
                                                                         $                            Form 1099-Q                     Education 
                                                                         2 Earnings                   (Rev. November 2019)            Programs 
                                                                                                      For calendar year               (Under Sections 
                                                                                                           20                         529 and 530)
                                                                         $
PAYER’S/TRUSTEE’S TIN               RECIPIENT’S TIN                      3 Basis                      4 Trustee-to-trustee        
                                                                                                        transfer                      Copy C
                                                                         $
RECIPIENT’S name                                                         5 Distribution is from:      6 Check if the recipient is     For Payer
                                                                         • Qualified tuition program—   not the designated            For Privacy Act 
                                                                                                        beneficiary
                                                                           Private       or State                                     and Paperwork 
Street address (including apt. no.)                                      • Coverdell ESA                                              Reduction Act 
                                                                                                                                      Notice, see the 
                                                                                                                                      current General 
City or town, state or province, country, and ZIP or foreign postal code                                                              Instructions for 
                                                                                                                                      Certain 
Account number (see instructions)                                                                                                     Information 
                                                                                                                                      Returns.
Form 1099-Q (Rev. 11-2019)                            www.irs.gov/Form1099Q                             Department of the Treasury - Internal Revenue Service

Instructions for Payer/Trustee
To complete Form 1099-Q, use:                               To file electronically, you must have software that 
• The current General Instructions for Certain              generates a file according to the specifications in Pub. 
Information Returns, and                                    1220. 
• The current Instructions for Form 1099-Q.                 Need help? If you have questions about reporting on 
                                                            Form 1099-Q, call the information reporting customer 
To order these instructions and additional forms, go        service site toll free at 866-455-7438 or304-263-8700 
to www.irs.gov/Form1099Q.                                   (not toll free). Persons with a hearing or speech 
Filing and furnishing. For filing and furnishing            disability with access to TTY/TDD equipment can call 
instructions, including due dates, and to request filing or 304-579-4827 (not toll free).
furnishing extensions, see the current General 
Instructions for Certain Information Returns.