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
8686
PAYER'S name, street address, city or town, state or province, country, ZIP
1 Unemployment compensation
OMB No. 1545-0120
or foreign postal code, and telephone no.
Certain
2019
$
Government
2 State or local income tax
Payments
refunds, credits, or offsets
1099-G
$
Form
Copy A
PAYER'S TIN
RECIPIENT'S TIN
3 Box 2 amount is for tax year
4 Federal income tax withheld
$
For
Internal Revenue
RECIPIENT'S name
5 RTAA payments
6 Taxable grants
Service Center
$
$
File with Form 1096.
7 Agriculture payments
8 Check if box 2 is
trade or business
For Privacy Act
$
Street address (including apt. no.)
income
and Paperwork
9 Market gain
Reduction Act
$
City or town, state or province, country, and ZIP or foreign postal code
Notice, see the 2019
General
10b State identification no. 11
State income tax withheld
10a State
Instructions for
$
2nd TIN not.
Account number (see instructions)
Certain Information
$
Returns.
1099-G
Form
Cat. No. 14438M
www.irs.gov/Form1099G
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
PAYER'S name, street address, city or town, state or province, country, ZIP
1 Unemployment compensation
OMB No. 1545-0120
or foreign postal code, and telephone no.
Certain
2019
$
Government
2 State or local income tax
Payments
refunds, credits, or offsets
1099-G
$
Form
PAYER'S TIN
RECIPIENT'S TIN
3 Box 2 amount is for tax year
4 Federal income tax withheld
Copy 1
$
For State Tax
RECIPIENT'S name
5 RTAA payments
6 Taxable grants
Department
$
$
7 Agriculture payments
8 Check if box 2 is
trade or business
$
Street address (including apt. no.)
income
9 Market gain
$
City or town, state or province, country, and ZIP or foreign postal code
10b State identification no. 11
State income tax withheld
10a State
$
Account number (see instructions)
$
1099-G
Form
www.irs.gov/Form1099G
Department of the Treasury - Internal Revenue Service
CORRECTED (if checked)
PAYER'S name, street address, city or town, state or province, country, ZIP
1 Unemployment compensation
OMB No. 1545-0120
or foreign postal code, and telephone no.
Certain
2019
$
Government
2 State or local income tax
Payments
refunds, credits, or offsets
1099-G
$
Form
Copy B
PAYER'S TIN
RECIPIENT'S TIN
3 Box 2 amount is for tax year
4 Federal income tax withheld
$
For Recipient
RECIPIENT'S name
5 RTAA payments
6 Taxable grants
This is important tax
$
$
information and is
being furnished to the
7 Agriculture payments
8 If checked, box 2 is
IRS. If you are required
trade or business
$
Street address (including apt. no.)
to file a return, a
income
negligence penalty or
9 Market gain
other sanction may be
$
imposed on you if this
City or town, state or province, country, and ZIP or foreign postal code
income is taxable and
10b State identification no. 11
State income tax withheld
10a State
the IRS determines that
$
Account number (see instructions)
it has not been
reported.
$
1099-G
Form
(keep for your records)
www.irs.gov/Form1099G
Department of the Treasury - Internal Revenue Service
Instructions for Recipient
interest is reported to you, report it as interest income on your tax return. See
your tax return instructions.
Recipient's taxpayer identification number (TIN). For your protection, this
Box 3. Identifies the tax year for which the box 2 refunds, credits, or offsets
form may show only the last four digits of your TIN (social security number
shown were made. If there is no entry in this box, the refund is for 2018 taxes.
(SSN), individual taxpayer identification number (ITIN), adoption taxpayer
Box 4. Shows backup withholding or withholding you requested on
identification number (ATIN), or employer identification number (EIN)). However,
unemployment compensation, Commodity Credit Corporation (CCC) loans, or
the issuer has reported your complete TIN to the IRS.
certain crop disaster payments. Generally, a payer must backup withhold on
Account number. May show an account or other unique number the payer has
certain payments if you did not give your taxpayer identification number to the
assigned to distinguish your account.
payer. See Form W-9 for information on backup withholding. Include this
Box 1. Shows the total unemployment compensation paid to you this year.
amount on your income tax return as tax withheld.
Combine the box 1 amounts from all Forms 1099-G and report the total as
Box 5. Shows reemployment trade adjustment assistance (RTAA) payments you
income on the unemployment compensation line of your tax return. Except as
received. Include on the "Other income" line of Schedule 1 (Form 1040).
explained below, this is your taxable amount. If you are married filing jointly,
Box 6. Shows taxable grants you received from a federal, state, or local
each spouse must figure his or her taxable amount separately. If you expect to
government.
Box 7. Shows your taxable Department of Agriculture payments. If the payer
receive these benefits in the future, you can ask the payer to withhold federal
shown is anyone other than the Department of Agriculture, it means the payer
income tax from each payment. Or, you can make estimated tax payments. For
has received a payment, as a nominee, that is taxable to you. This may
details, see Form 1040-ES. If you made contributions to a governmental
represent the entire agricultural subsidy payment received on your behalf by the
unemployment compensation program or to a governmental paid family leave
nominee, or it may be your pro rata share of the original payment. See Pub. 225
program and received a payment from that program, the payer must issue a
and the Instructions for Schedule F (Form 1040) for information about where to
separate Form 1099-G to report this amount to you. If you itemize deductions,
report this income. Partnerships, see Form 8825 for how to report.
you may deduct your contributions on Schedule A (Form 1040) as taxes paid. If
Box 8. If this box is checked, the amount in box 2 is attributable to an income
you do not itemize, you only need to include in income the amount that is in
tax that applies exclusively to income from a trade or business and is not a tax
excess of your contributions.
of general application. If taxable, report the amount in box 2 on Schedule C or F
Box 2. Shows refunds, credits, or offsets of state or local income tax you
(Form 1040), as appropriate.
received. It may be taxable to you if you deducted the state or local income tax
Box 9. Shows market gain on CCC loans whether repaid using cash or CCC
paid on Schedule A (Form 1040). Even if you did not receive the amount shown,
certificates. See the Instructions for Schedule F (Form 1040).
for example, because: (a) it was credited to your state or local estimated tax, (b)
Boxes 10a–11. State income tax withheld reporting boxes.
it was offset against federal or state debts, (c) it was offset against other offsets,
Future developments. For the latest information about developments related to
or (d) you made a charitable contribution from your refund, it is still taxable if it
Form 1099-G and its instructions, such as legislation enacted after they were
was deducted. If you received interest on this amount, you may receive Form
published, go to www.irs.gov/Form1099G.
1099-INT for the interest. However, the payer may include interest of less than
$600 in the blank box next to box 9 on Form 1099-G. Regardless of whether the
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