IRS Form 1099-R "Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, Iras, Insurance Contracts, Etc."

This version of the IRS Form 1099-R is not currently in use and is provided for reference only.
Download this version of IRS Form 1099-R to file for the current year.

What Is IRS Form 1099-R?

This is a tax form that was released by the Internal Revenue Service (IRS) - a subdivision of the U.S. Department of the Treasury. As of today, no separate filing guidelines for the form are provided by the IRS.

Form Details:

  • A 11-page form available for download in PDF;
  • This form cannot be used to file taxes for the current year. Choose a more recent version to file for the current tax year;
  • Editable, printable, and free;

Download a fillable version of IRS Form 1099-R through the link below or browse more documents in our library of IRS Forms.

ADVERTISEMENT
ADVERTISEMENT

Download IRS Form 1099-R "Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, Iras, Insurance Contracts, Etc."

918 times
Rate (4.8 / 5) 45 votes
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.
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.
VOID
CORRECTED
9898
Distributions From
PAYER’S name, street address, city or town, state or province,
1 Gross distribution
OMB No. 1545-0119
country, ZIP or foreign postal code, and phone no.
Pensions, Annuities,
Retirement or
2018
$
Profit-Sharing Plans,
2a Taxable amount
IRAs, Insurance
Contracts, etc.
1099-R
$
Form
2b Taxable amount
Total
Copy A
not determined
distribution
For
PAYER’S TIN
RECIPIENT’S TIN
3 Capital gain (included
4
Internal Revenue
Federal income tax
in box 2a)
withheld
Service Center
File with Form 1096.
$
$
RECIPIENT’S name
5
6 Net unrealized
Employee contributions/
For Privacy Act
Designated Roth
appreciation in
contributions or
employer’s securities
and Paperwork
insurance premiums
Reduction Act
$
$
Notice, see the
2018 General
Street address (including apt. no.)
7 Distribution
IRA/
8 Other
SEP/
Instructions for
code(s)
SIMPLE
Certain
$
%
Information
9b
9a
Total employee contributions
City or town, state or province, country, and ZIP or foreign postal code
Your percentage of total
Returns.
distribution
$
%
10
11 1st year of
12
13 State/Payer’s state no. 14 State distribution
Amount allocable to IRR
FATCA filing
State tax withheld
requirement
within 5 years
desig. Roth contrib.
$
$
$
$
$
Account number (see instructions)
Date of
15
16 Name of locality
17 Local distribution
Local tax withheld
payment
$
$
$
$
1099-R
Form
Cat. No. 14436Q
www.irs.gov/Form1099R
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
Distributions From
PAYER’S name, street address, city or town, state or province,
1 Gross distribution
OMB No. 1545-0119
country, ZIP or foreign postal code, and phone no.
Pensions, Annuities,
Retirement or
2018
$
Profit-Sharing Plans,
2a Taxable amount
IRAs, Insurance
Contracts, etc.
1099-R
$
Form
2b Taxable amount
Total
Copy 1
not determined
distribution
For
PAYER’S TIN
RECIPIENT’S TIN
3 Capital gain (included
4
Federal income tax
State, City,
in box 2a)
withheld
or Local
Tax Department
$
$
RECIPIENT’S name
5
6 Net unrealized
Employee contributions/
Designated Roth
appreciation in
contributions or
employer’s securities
insurance premiums
$
$
Street address (including apt. no.)
7 Distribution
IRA/
8 Other
SEP/
code(s)
SIMPLE
$
%
9b
9a
Total employee contributions
City or town, state or province, country, and ZIP or foreign postal code
Your percentage of total
distribution
$
%
10
11 1st year of
12
13 State/Payer’s state no. 14 State distribution
Amount allocable to IRR
FATCA filing
State tax withheld
requirement
within 5 years
desig. Roth contrib.
$
$
$
$
$
Account number (see instructions)
Date of
15
16 Name of locality
17 Local distribution
Local tax withheld
payment
$
$
$
$
1099-R
Form
www.irs.gov/Form1099R
Department of the Treasury - Internal Revenue Service
CORRECTED (if checked)
Distributions From
PAYER’S name, street address, city or town, state or province,
1 Gross distribution
OMB No. 1545-0119
country, ZIP or foreign postal code, and phone no.
Pensions, Annuities,
Retirement or
2018
$
Profit-Sharing Plans,
2a Taxable amount
IRAs, Insurance
Contracts, etc.
1099-R
$
Form
Copy B
2b Taxable amount
Total
not determined
distribution
Report this
income on your
PAYER’S TIN
RECIPIENT’S TIN
3 Capital gain (included
4
Federal income tax
in box 2a)
withheld
federal tax
return. If this
form shows
$
$
federal income
RECIPIENT’S name
5
6 Net unrealized
Employee contributions/
tax withheld in
Designated Roth
appreciation in
box 4, attach
contributions or
employer’s securities
this copy to
insurance premiums
your return.
$
$
Street address (including apt. no.)
7 Distribution
IRA/
8 Other
SEP/
code(s)
This information is
SIMPLE
being furnished to
$
%
the IRS.
9b
9a
Total employee contributions
City or town, state or province, country, and ZIP or foreign postal code
Your percentage of total
distribution
$
%
10
11 1st year of
12
13 State/Payer’s state no. 14 State distribution
Amount allocable to IRR
FATCA filing
State tax withheld
requirement
within 5 years
desig. Roth contrib.
$
$
$
$
$
Account number (see instructions)
Date of
15
16 Name of locality
17 Local distribution
Local tax withheld
payment
$
$
$
$
1099-R
Form
www.irs.gov/Form1099R
Department of the Treasury - Internal Revenue Service
Instructions for Recipient
Box 1. Shows the total amount you received this year. The amount
may have been a direct rollover, a transfer or conversion to a Roth
Generally, distributions from retirement plans (IRAs, qualified plans,
IRA, a recharacterized IRA contribution; or you may have received it
section 403(b) plans, and governmental section 457(b) plans),
as periodic payments, as nonperiodic payments, or as a total
insurance contracts, etc., are reported to recipients on Form 1099-R.
distribution. Report the amount on Form 1040 or 1040NR on the line
Qualified plans and section 403(b) plans. If your annuity starting
for “IRAs, pensions, and annuities” (or the line for “Taxable amount”),
date is after 1997, you must use the simplified method to figure your
and on Form 8606, as applicable. However, if this is a lump-sum
taxable amount if your payer didn’t show the taxable amount in box
distribution, see Form 4972. If you haven’t reached minimum
2a. See the instructions for Form 1040 or 1040NR.
retirement age, report your disability payments on the line for “Wages,
IRAs. For distributions from a traditional individual retirement
salaries, tips, etc.” on your tax return. Also report on that line
arrangement (IRA), simplified employee pension (SEP), or savings
permissible withdrawals from eligible automatic contribution
incentive match plan for employees (SIMPLE), generally the payer isn’t
arrangements and corrective distributions of excess deferrals, excess
required to compute the taxable amount. See the Form 1040 or
contributions, or excess aggregate contributions except if the
1040NR instructions to determine the taxable amount. If you are at
distribution is of designated Roth contributions or your after-tax
least age 70½, you must take minimum distributions from your IRA
contributions or if you are self-employed.
(other than a Roth IRA). If you don’t, you are subject to a 50% excise
If a life insurance, annuity, qualified long-term care, or endowment
tax on the amount that should’ve been distributed. See Pub. 590-A
contract was transferred tax free to another trustee or contract issuer,
and Pub. 590-B for more information on IRAs.
an amount will be shown in this box and code 6 will be shown in box
Roth IRAs. For distributions from a Roth IRA, generally the payer isn’t
7. If a charge or payment was made against the cash value of an
required to compute the taxable amount. You must compute any
annuity contract or the cash surrender value of a life insurance
taxable amount on Form 8606. An amount shown in box 2a may be
contract for the purchase of qualified long-term care insurance, an
taxable earnings on an excess contribution.
amount will be shown in this box and code W will be shown in box 7.
Loans treated as distributions. If you borrow money from a qualified
You need not report these amounts on your tax return. If code C is
plan, section 403(b) plan, or governmental section 457(b) plan, you
shown in box 7, the amount shown in box 1 is a receipt of reportable
may have to treat the loan as a distribution and include all or part of
death benefits that is taxable in part.
the amount borrowed in your income. There are exceptions to this
Box 2a. This part of the distribution is generally taxable. If there is no
rule. If your loan is taxable, code L will be shown in box 7. See
entry in this box, the payer may not have all the facts needed to figure
Pub. 575.
the taxable amount. In that case, the first box in box 2b should be
Recipient’s taxpayer identification number (TIN). For your
checked. You may want to get one of the free publications from the
protection, this form may show only the last four digits of your TIN
IRS to help you figure the taxable amount. See Additional information
(SSN, ITIN, ATIN, or EIN). However, the payer has reported your
on the back of Copy 2. For an IRA distribution, see IRAs and Roth
complete TIN to the IRS.
IRAs on this page. For a direct rollover, other than from a qualified
FATCA filing requirement. If the FATCA filing requirement box is
plan to a Roth IRA, zero should be shown, and you must enter zero
checked, the payer is reporting on this Form 1099 to satisfy its
(-0-) on the “Taxable amount” line of your tax return. If you roll over a
chapter 4 account reporting requirement. You also may have a filing
distribution (other than a distribution from a designated Roth account)
requirement. See the Instructions for Form 8938.
from a qualified plan (including a governmental section 457(b) plan) or
Account number. May show an account, policy, or other unique
section 403(b) plan to a Roth IRA, you must include on the “Taxable
number the payer assigned to distinguish your account.
amount” line of your tax return the amount shown in this box plus the
Date of payment. Shows the date of payment for reportable death
amount in box 6, if any. (Continued on the back of Copy C.)
benefits under section 6050Y.