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        FORM                                 STATE OF HAWAII — DEPARTMENT OF TAXATION
                      
        N-196                                Annual Summary and Transmittal of
        (REV. 2020)                                                                                                                                      20__
    CORRECTED                                       Hawaii Information Returns
  FILER’S name
                                                                               In Box 1 or 2 below, enter the identification number used when 
                                                                               filing the information returns being transmitted.  Fill in either box 
                                                                               1 or 2, not both.

  Street address                                                             1  Federal Employer I.D. Number 2  Social Security Number

  City, State, and Postal/ZIP code                                           3  Total number of forms        4  Totalthis FormamountN-196.reported with  
                                                                                                                                                        
 Check only one box below to indicate the type of form being transmitted:        If this is your FINAL return, check here.   
  Name of person to contact if  
  the Department of Taxation       1099-     1099-      1099-   1099-                 1099-             1099-             1099-                          1099- 1099- 
  needs more information. 
                                   DIV       G              INT              K        MISC               NEC                  OID                        PATR  R 
  Telephone Number                                                                                                                                     
  (                 )
        I hereby declare under penalties set forth in section 231-36, HRS, that to the best of my knowledge and belief, the accompanying documents constitute a true 
and complete return of payments of the above described classes of income made by the person or organization named above during the calendar year indicated 
above.

 (Authorized Signature)                                                                         (Title)                                   (Date)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  DETACH HERE ------------------------------------------
                                                        GENERAL INFORMATION
Purpose of Form — Use this form to transmit State copies of paper 1099        from the taxpayer.  For further information, see federal Publication 1220.
forms to the Department of Taxation (Department). The use of federal 
Forms 1099-DIV, 1099-G, 1099-INT, 1099-K, 1099-MISC, 1099-NEC,                Certain Federal Filings Not the Same for Hawaii — Hawaii has no 
1099-OID, 1099-PATR, and 1099-R are required, as the Department is            plans at this time to require the filing of the following forms since there 
not printing its own version of these forms.  Also use this form to transmit  are no statutory provisions requiring such filing:
State copies of corrected 1099 forms to the Department.                         — Form 1098, Mortgage Interest Statement,
Who Must File Forms 1099  With the Hawaii Department of                         — Form 1098-C, Contributions of Motor Vehicles, Boats, and 
Taxation — Every person engaged in a trade or business in Hawaii                      Airplanes
or having a place of business or a fiscal or paying office in Hawaii and        — Form 1098-E, Student Loan Interest Statement
making payments in the course of such trade or business to another              — Form 1098-T, Tuition Statement
person must make a separate information return on Form 1099.                    — Form 1099-A, Acquisition or Abandonment of Secured 
Internet Address — Forms and other tax information may be                             Property,
downloaded from the Department’s website at: tax.hawaii.gov.                    — Form 1099-B, Proceeds From Broker and Barter Exchange 
Foreign Items — In the case of foreign items, i.e., interest upon the bonds           Transactions,
of a foreign country or of a nonresident corporation organized and existing     — Form 1099-C, Cancellation of Debt
under the laws of a foreign country not having a fiscal agent or paying         — Form 1099-CAP, Changes in Corporate Control and Capital 
agent in Hawaii, or any items of dividends upon stock of such corporation,            Structure
a return on Form 1099 shall be filed by any person who accepts the items        — Form 1099-H, Health Coverage Tax Credit (HCTC) Advance 
for collection, such as a bank as defined in section 241-1, HRS, if the               Payments
amount paid to a resident individual of Hawaii, a fiduciary of a resident       — Form 1099-LTC, Long-Term Care and Accelerated Death 
estate or trust, or a resident partnership, any member of which is a                  Benefits
resident of Hawaii, during the calendar year is $600 or more.                   — Form 1099-Q, Payments From Qualified Education 
Nominee/Middleman Returns — Generally, anyone receiving amounts                       Programs (Under Sections 529 and 530)
that actually belong to another person should file a Form 1099 showing          — Form 1099-S, Proceeds From Real Estate Transactions,
the actual owner as the recipient and the nominee as the payer.                 — Form 1099-SA, Distributions From an HSA, Archer MSA, or 
Use of Substitute Forms            — Persons wishing to use a substitute of           Medicare Advantage MSA 
Form N-196 must comply with the Department’s most current Forms                 — Form 5498, IRA Contribution Information,
Reproduction Policy.  Persons using substitute Forms 1099 may use               — Form 5498-ESA, Coverdell ESA Contribution Information, and
any forms approved for federal filing.                                          — Form 5498-SA, HSA, Archer MSA or Medicare Advantage MSA 
                                                                                      Information
Electronic Filing — The State of Hawaii participates in the combined 
federal/state electronic filing program which was established to simplify     In addition, the Hawaii Income Tax Law does not conform to the federal 
information returns filing for taxpayers. The Internal Revenue Service        reporting requirements of the following:
(IRS) will accept, upon prior approval, electronic files containing Hawaii 
reporting information. No other report to the Department is necessary.          — Backup withholding, and
If properly coded, corrections filed with the IRS electronically will be        — Electronic reporting for interest, dividends, and broker and 
forwarded to the Department, otherwise, corrected returns must be filed               barter exchange transactions.
with the Department on the appropriate paper forms. The Department   
does not accept any Form N-196 or Form 1099 filed electronically directly 
                                                                                                                                                               FORM N-196

FORM N-196 
(REV. 2020)                                                                                                               PAGE 2

                        INSTRUCTIONS FOR COMPLETING AND FILING FORM N-196

Completing Form N-196 —                                                    b. Have the responsibility (either oral, written, or implied) 
                                                                           conferred on it by the payer to request the taxpayer 
1. Enter the last two digits of the calendar year (upper right corner)     identifying numbers; and
for which this Form N-196 is being completed.
                                                                           c. Sign the affidavit and add the caption “For (Name of payer).”
2. Enter the filer’s name and address in the appropriate area on 
the form.                                                                  Preparing Corrected Forms —       If you are preparing corrected 
                                                                           Forms 1099, place an “X” in the “CORRECTED” box at the top of 
3. Enter the filer’s taxpayer identification number in either Box 1        Form N-196 and on the corrected Forms 1099 being submitted. 
or Box 2.  Individuals not in a trade or business should enter their       Do not include original Forms 1099 with your corrected forms 
social security number in Box 2. Sole proprietors and all others           being filed. Complete all the requested information on the 
should enter their federal employer identification number in Box 1.        corrected forms since these forms replace the forms previously 
Sole proprietors who are not required to have a federal employer           submitted. Statements issued to recipients must be identified as 
identification number should enter their social security number in         “CORRECTED.” Corrected forms may be filed electronically. See 
Box 2. Do not fill in both Boxes 1 and 2.                                  Electronic Filing for information.
                                                                           FILING FORM N-196 —  Form N-196 and Forms 1099 must be 
4. In Box 3, enter the number of 1099 forms you are filing with this       filed on the basis of the calendar year even though your income tax 
Form N-196. Do not include blank or voided forms in your total.            return is filed on the basis of a fiscal year.
Enter the number of correctly completed forms, not the number of 
pages, being filed. For example, if you send one page of three-to-         When to File — File Form N-196 and State copies of Forms 1099 
a-page Forms 1099-DIV with a Form N-196 and you have correctly             on or before February 28 of the following year. If the due date falls 
                                                                           on a Saturday, Sunday, or legal holiday, file by the next regular 
completed two Forms 1099-DIV on that page, enter 2 in Box 3 of             workday. Hawaii has adopted the Internal Revenue Code provision 
Form N-196.                                                                to allow documents and payments delivered by a designated private 
5. Enter in Box 4 the total of the amounts from the specific boxes of      delivery service to qualify for the “timely mailing treated as timely 
                                                                           filing/paying rule.”  The Department will conform to the Internal 
the forms listed below:                                                    Revenue Service listing of designated private delivery service and 
Form 1099-DIV           Boxes 1a, 2a, 3, 8, and 9                          type of delivery services qualifying under this provision. Timely filing 
Form 1099-G             No entry needed.                                   of mail which does not bear the U.S. Post Office cancellation mark 
                                                                           or the date recorded or marked by the designated delivery service 
Form 1099-INT           Boxes 1, 3, and 8                                  will be determined by reference to other competent evidence. The 
Form 1099-K             Box 1                                              private delivery service can tell you how to get written proof of the 
Form 1099-MISC          Boxes 1, 2, 3, 5, 6, 7, 8, 10, 13, and 14          mailing date.
Form 1099-NEC           Box 1 
Form 1099-OID           Boxes 1, 2, and 8                                  Where to File — File Form N-196 and State copies of Forms 1099 
                                                                           to the Hawaii Department of Taxation at: P.O. Box 3559, Honolulu, 
Form 1099-PATR          Boxes 1, 2, 3, and 5                               HI 96811-3559, or at 830 Punchbowl St., Room 126, Honolulu, HI  
Form 1099-R             Box 1                                              96813-5094
6. Check the appropriate box to indicate the type of 1099 form you         Shipping  and Mailing — If you are sending  a large number  of 
are filing. If you must file several different 1099 forms, each type       forms, you may send them in conveniently sized packages. On 
must be filed with a separate Form N-196. For example, if you pay          each package, write your name and identifying number. Number the 
both interest and dividends, file Forms 1099-INT with one Form             packages consecutively and place Form N-196 in package number 
N-196 and Forms 1099-DIV with a second Form N-196.                         one.  At  the  top  of  Form  N-196,  show  the  number  of  packages. 
                                                                           Postal regulations require that forms and packages be sent by first 
7. If this is your final filing of Forms 1099, check the box under Box 4.  class mail.
8. In the appropriate box, indicate the name and telephone number          Statements to Recipients — Statements to income recipients are 
of a contact person if the Department needs more information.              to be in a form that is permitted by the Internal Revenue Service. 
                                                                           Statements may be furnished electronically to income recipients 
9. Form N-196 must be signed by someone having the authority               who have consented to receive electronic copies. Statements are 
to do so. Under certain conditions, a transmitter, service bureau,         to be furnished to income recipients by February 28 of the following 
paying agent, or disbursing agent may sign the affidavit on behalf         year. Federal provisions require the statements to be furnished 
                                                                           by January 31 of the following year. It is not necessary to provide 
of the payer.  The transmitter, service bureau, paying agent, or           a separate State statement. Statements may be issued earlier in 
disbursing agent must meet all the following conditions:                   some situations. You may, for example, furnish a statement if it 
a. Have the authority to sign the affidavit under an agency                is with a final interest payment for the year, after redemption or 
                                                                           maturity of an obligation, or after final withdrawal if it is after April 
agreement (either oral, written, or implied) that is valid                 30th of the year.
under State law;