IRS Form 1098-F 2019 Fines, Penalties, and Other Amounts

IRS Form 1098-F is a U.S. Department of the Treasury - Internal Revenue Service - issued form also known as the "Fines, Penalties, And Other Amounts".

A PDF of the latest IRS Form 1098-F can be downloaded below or found on the U.S. Department of the Treasury - Internal Revenue Service Forms and Publications website.

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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
0303
FILER’S name, street address, city or town, state or province, country, ZIP or
1 Total amount required to be
OMB No. 1545-2284
paid
foreign postal code, and telephone number
2019
Fines, Penalties, and
$
Other Amounts
2 Restitution/remediation
amount
1098-F
$
Form
Copy A
FILER’S TIN
PAYER’S TIN
3 Compliance amount
4 Date of order/agreement
$
For
Internal Revenue
PAYER’S name
5 Jurisdiction
Service Center
6 Case Number
File with Form 1096.
Street address (including apt. no.)
For Privacy Act and
Paperwork Reduction
7 Name or description of matter/suit/agreement
Act Notice, see the
City or town, state or province, country, and ZIP or foreign postal code
2019 General
8 Code
Instructions for
Certain Information
Returns.
1098-F
Form
Cat. No. 71382B
Department of the Treasury - Internal Revenue Service
www.irs.gov/Form1098F
Do Not Cut or Separate Forms on This Page
Do Not Cut or Separate Forms on This Page
CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP or
1 Total amount required to be
OMB No. 1545-2284
paid
foreign postal code, and telephone number
2019
Fines, Penalties, and
$
Other Amounts
2 Restitution/remediation
amount
1098-F
$
Form
Copy B
FILER’S TIN
PAYER’S TIN
3 Compliance amount
4 Date of order/agreement
$
For Payer
PAYER’S name
5 Jurisdiction
6 Case Number
Street address (including apt. no.)
This is important tax
7 Name or description of matter/suit/agreement
information and is
City or town, state or province, country, and ZIP or foreign postal code
being furnished to
8 Code
the IRS.
1098-F
Form
(keep for your records)
Department of the Treasury - Internal Revenue Service
www.irs.gov/Form1098F
Instructions for Payer
Box 6. Shows the case number associated with the court order or
agreement, if applicable.
This statement has been furnished to you by a government or
Box 7. Provides a name or description to identify the underlying case or
governmental entity regarding a court order or agreement with respect to a
matter to which the court order or agreement relates.
violation or potential violation of law. Retain this statement for your
records.
Box 8. Shows one or more of the following codes.
Payer’s taxpayer identification number (TIN). For your protection, this
A—Multiple payments.
form may show only the last four digits of your TIN (social security number
B—Multiple payers/defendants.
(SSN), individual taxpayer identification number (ITIN), adoption taxpayer
C—Multiple payees.
identification number (ATIN), or employer identification number (EIN)).
However, the issuer has reported your complete TIN to the IRS.
D—Property required to be acquired, constructed, or transferred under the
court order or agreement.
Box 1. Shows the total amount required to be paid in relation to the violation or
potential violation of law as stated in the court order or agreement.
E—Payment to third party other than government or governmental entity.
Box 2. Shows the amount of restitution or remediation required to be paid
F—Paid in full as of time of filing.
as stated in the court order or agreement.
G—No payment received as of time of filing.
Box 3. Shows the amount identified in the court order or agreement as
H—Deferred prosecution agreement.
required to be paid for purposes of coming into compliance with any law.
Future developments. For the latest information about developments related
Box 4. Shows the date the order was entered by the court or the
to Form 1098-F and its instructions, such as legislation enacted after they were
agreement was fully executed.
published, go to www.irs.gov/Form1098F.
Box 5. Shows the name of the court that entered the order or approved the
agreement, if applicable.
VOID
CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP or
1 Total amount required to be
OMB No. 1545-2284
foreign postal code, and telephone number
paid
2019
Fines, Penalties, and
$
Other Amounts
2 Restitution/remediation
amount
1098-F
$
Form
Copy C
FILER’S TIN
PAYER’S TIN
3 Compliance amount
4 Date of order/agreement
$
For Filer
PAYER’S name
5 Jurisdiction
6 Case Number
For Privacy Act and
Street address (including apt. no.)
Paperwork Reduction
7 Name or description of matter/suit/agreement
Act Notice, see the
2019 General
City or town, state or province, country, and ZIP or foreign postal code
Instructions for
8 Code
Certain Information
Returns.
1098-F
Form
www.irs.gov/Form1098F
Department of the Treasury - Internal Revenue Service

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