Form CT-4804 "Transmittal of Information Returns Reported on Compact Disc (Cd)" - Connecticut

What Is Form CT-4804?

This is a legal form that was released by the Connecticut Department of Revenue Services - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2017;
  • The latest edition provided by the Connecticut Department of Revenue Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CT-4804 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Revenue Services.

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Download Form CT-4804 "Transmittal of Information Returns Reported on Compact Disc (Cd)" - Connecticut

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Form CT- 4804
Department of Revenue Services
For DRS Use Only
State of Connecticut
Transmittal of Information Returns
PO Box 5081
Hartford CT 06102-5081
Reported on Compact Disc (CD)
(Rev. 11/17)
For Forms W-2G, 1099-R, and 1099-MISC
.
Complete this form in blue or black ink only.
Payers are required to file Forms 1099-R, 1099-MISC, and W-2G electronically. Payers using Form CT-4804 must have
a valid DRS waiver from the electronic requirement. See instructions.
1. File type
2. Calendar year reported on CDs
3. Transmitter’s Federal Employer ID Number (FEIN)
Original
Replacement
4. Number of CDs shipped
5. Number of payee records reported with transmission
6. Transmitter name
Street address
City
State
ZIP code
7. Person to contact if there is a problem processing the CD(s)
Name
Title
Telephone number
(
)
8. Payer summary of
information
returns reported on CD. Complete for each payer transmitted.
Name of payer
Name of payer
Street address
Street address
City
State
ZIP Code
City
State
ZIP Code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
Federal Employer ID Number
Federal Employer ID Number
Type of return
Type of return
Number of Forms 1099 or W-2G submitted
Number of Forms 1099 or W-2G submitted
Total nonpayroll amounts reported
Total nonpayroll amounts reported
Connecticut tax withheld
Connecticut tax withheld
Name of payer
Name of payer
Street address
Street address
City
State
ZIP Code
City
State
ZIP Code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
Federal Employer ID Number
Federal Employer ID Number
Type of return
Type of return
Number of Forms 1099 or W-2G submitted
Number of Forms 1099 or W-2G submitted
Total nonpayroll amounts reported
Total nonpayroll amounts reported
Connecticut tax withheld
Connecticut tax withheld
See Declaration Requirements on Back.
Declaration: I declare under the penalty of law that I have examined this return (including any accompanying schedules and statements)
and, to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return
or document to the Department of Revenue Services (DRS) is a fine of not more than $5,000, or imprisonment for not more than five years,
or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Signature
Title
Date
P:\Special\AFP\PROD\FORMS\17\CT\CT-4804\Form CT-4804 Final Approved
20171204
Form CT- 4804
Department of Revenue Services
For DRS Use Only
State of Connecticut
Transmittal of Information Returns
PO Box 5081
Hartford CT 06102-5081
Reported on Compact Disc (CD)
(Rev. 11/17)
For Forms W-2G, 1099-R, and 1099-MISC
.
Complete this form in blue or black ink only.
Payers are required to file Forms 1099-R, 1099-MISC, and W-2G electronically. Payers using Form CT-4804 must have
a valid DRS waiver from the electronic requirement. See instructions.
1. File type
2. Calendar year reported on CDs
3. Transmitter’s Federal Employer ID Number (FEIN)
Original
Replacement
4. Number of CDs shipped
5. Number of payee records reported with transmission
6. Transmitter name
Street address
City
State
ZIP code
7. Person to contact if there is a problem processing the CD(s)
Name
Title
Telephone number
(
)
8. Payer summary of
information
returns reported on CD. Complete for each payer transmitted.
Name of payer
Name of payer
Street address
Street address
City
State
ZIP Code
City
State
ZIP Code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
Federal Employer ID Number
Federal Employer ID Number
Type of return
Type of return
Number of Forms 1099 or W-2G submitted
Number of Forms 1099 or W-2G submitted
Total nonpayroll amounts reported
Total nonpayroll amounts reported
Connecticut tax withheld
Connecticut tax withheld
Name of payer
Name of payer
Street address
Street address
City
State
ZIP Code
City
State
ZIP Code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
Federal Employer ID Number
Federal Employer ID Number
Type of return
Type of return
Number of Forms 1099 or W-2G submitted
Number of Forms 1099 or W-2G submitted
Total nonpayroll amounts reported
Total nonpayroll amounts reported
Connecticut tax withheld
Connecticut tax withheld
See Declaration Requirements on Back.
Declaration: I declare under the penalty of law that I have examined this return (including any accompanying schedules and statements)
and, to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return
or document to the Department of Revenue Services (DRS) is a fine of not more than $5,000, or imprisonment for not more than five years,
or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Signature
Title
Date
P:\Special\AFP\PROD\FORMS\17\CT\CT-4804\Form CT-4804 Final Approved
20171204
Form CT-4804 - Instructions
General Instructions
The authorized agent’s signing of the declaration on the payer’s
behalf does not relieve the payer of the responsibility for filing a
Complete this form in blue or black ink only.
correct, complete, and timely Form CT-4804, or the applicable
Payers are required to file Forms 1099-R, 1099-MISC, and W-2G
penalties.
electronically.
CD Labels
Only payers that receive a DRS waiver from electronically submitting
Each CD must be labeled with an external label. See Example below.
Forms 1099-R, 1099-MISC, and W-2G may submit information
returns to DRS on CD. To request a waiver from the electronic
The external label must identify:
requirement complete Form CT-8508, Request for Waiver From
1.
File type: Indicate if the file is original or replacement.
Filing Information Returns Electronically, and mail to DRS on or
2.
Calendar year: The calendar year for which the file is prepared.
before January 1.
Only one year may be reported per file.
Use Form CT-4804, Transmittal of Information Returns Reported
3.
Transmitter name: The name of the organization transmitting
on Compact Disc (CD), when sending information returns on CD
this file. The entry should be the same organization recorded
to DRS. Attach Form CT-1096, Connecticut Annual Summary and
on the Transmitter Record (T Record) of this file.
Transmittal of Information Returns, only if Connecticut tax was
withheld.
4.
FEIN: The nine-digit Federal Employer Identification Number
(FEIN) of the organization transmitting the file. The FEIN on
Group the returns by return type and transmit each group with
the label should be the same as the FEIN recorded on the
a separate Form CT-4804. Use Form CT-4802, Transmittal of
Transmitter Record (T Record) of the file.
Information Returns Reported on Compact Disc (CD) Continuation,
to report more than four payers.
5.
No. of payers: The number of payers (A Records) on the file.
Line Instructions
6.
No. of payees: The number of payees (B Records) on the file.
7.
Record length: The only acceptable record length is 750.
Line 1: Check if CD is an original or replacement file.
8.
Volume: Number multiple CD’s sequential as Vol. 1 of X. The
Line 2: Enter calendar year reported on CD. Report one calendar
first CD of a two CD file is labeled Vol. 1 of 2.
year per file.
9.
Contact information: Name and telephone number of the
Line 3: Enter transmitter’s Federal Employer Identification Number
person to contact about this filing.
(FEIN).
Send CDs with transmittal form(s) to:
Line 4: Enter the number of CDs submitted with this form.
Department of Revenue Services
Line 5: Enter total payee records submitted with this form.
State of Connecticut
Line 6: Enter transmitter name and address
PO Box 5081
Line 7: Enter name, title, and telephone number of person to contact
Hartford CT 06102-5081
about problem CDs.
If a PO Box cannot be used, send to:
Line 8: Use this section to report information for up to four payers.
Department of Revenue Services
If additional space is needed, use Form CT-4802.
State of Connecticut
Declaration Requirements
Attn: Processing
450 Columbus Blvd Ste 1
A transmitter, service bureau, paying agent, or disbursing agent
Hartford CT 06103-1837
(agent) may sign Form CT-4804 on behalf of the payer (or other
person required to file) if both conditions below are met:
Do not send paper Forms 1099-MISC, 1099-R, or W-2G.
1. The agent has the authority to sign the form under an agency
Forms and Publications
agreement (oral, written, or implied) that is valid under state
Visit the DRS website at www.ct.gov/DRS to download and print
law; and
Connecticut tax forms and publications.
2. The agent signs the form and adds the caption “For: (name of
TTY, TDD, and Text Telephone users only may transmit inquiries
payer or other person required to file).”
anytime by calling 860-297-4911.
Example:
Forms 1099
and W-2G CD Label
2. Calendar year
3. Transmitter FEIN
1. File type
Original
Replacement
4. Transmitter name
5. Number of payers
6. Number of payees
7. Return type
 1099-MISC
1099-R
 W-2G
8. Volume
9. Contact name
Telephone number
(
)
Vol. _____ of _____
Form CT- 4804 Back (Rev. 11/17)
P:\Special\AFP\PROD\FORMS\17\CT\CT-4804\Form CT-4804 Final Approved
20171204
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