Fill Out a Valid IRS 1096 Template

Form 1096

Annual Summary and Transmittal of

OMB No. 1545-0108

2022

Department of the Treasury

U.S. Information Returns

Internal Revenue Service

FILER’S name

Street address (including room or suite number)

City or town, state or province, country, and ZIP or foreign postal code

For Official Use Only

Name of person to contact

Telephone number

Email address

Fax number

1 Employer identification number

2 Social security number

3 Total number of forms

4 Federal income tax withheld

5 Total amount reported with this Form 1096

$

$

Signature ▶

Title ▶

Date ▶

Instructions

Enter the filer’s name, address (including room, suite, or other unit

Future developments. For the latest information about developments

number), and taxpayer identification number (TIN) in the spaces

provided on the form. The name, address, and TIN of the filer on this

related to Form 1096, such as legislation enacted after it was

form must be the same as those you enter in the upper left area of

published, go to www.irs.gov/Form1096.

Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.

Reminder. The only acceptable method of electronically filing

When to file. File Form 1096 as follows.

information returns listed on this form in box 6 with the IRS is through

• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by

the FIRE System. See Pub. 1220.

February 28, 2023.

Purpose of form. Use this form to transmit paper Forms 1097, 1098,

• With Forms 1099-NEC, file by January 31, 2023.

1099, 3921, 3922, 5498, and W-2G to the IRS.

• With Forms 5498, file by May 31, 2023.

Caution: If you are required to file 250 or more information returns of

any one type (excluding Form 1098-F), you must file electronically. If

Where To File

you are required to file electronically but fail to do so, and you do not

Send all information returns filed on paper with Form 1096 to the

have an approved waiver, you may be subject to a penalty. The

Taxpayer First Act of 2019, enacted July 1, 2019, authorized the

following.

Department of the Treasury and the IRS to issue regulations that

If your principal business, office

reduce the 250-return requirement for 2021 tax returns. If those

Use the following

or agency, or legal residence in

regulations are issued and effective for 2022 tax returns required to be

the case of an individual, is

address

filed in 2023, we will post an article at www.irs.gov/Form1099

located in

explaining the change. Until regulations are issued, however, the

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▲

number remains at 250, as reflected in these instructions. For more

information, see part F in the 2022 General Instructions for Certain

Alabama, Arizona, Arkansas, Delaware,

Information Returns.

Florida, Georgia, Kentucky, Maine,

Internal Revenue Service

Massachusetts, Mississippi, New

Forms 1099-QA and 5498-QA can be filed on paper only, regardless

P.O. Box 149213

Hampshire, New Jersey, New Mexico,

of the number of returns.

New York, North Carolina, Ohio, Texas,

Austin, TX 78714-9213

Who must file. Any person or entity who files any of the forms shown

Vermont, Virginia

in line 6 above must file Form 1096 to transmit those forms to the IRS.

Caution: Your name and TIN must match the name and TIN used on

your 94X series tax return(s) or you may be subject to information

return penalties. Do not use the name and/or TIN of your paying agent

or service bureau.

For more information and the Privacy Act and Paperwork Reduction Act Notice,

Cat. No. 14400O

Form 1096 (2022)

see the 2022 General Instructions for Certain Information Returns.

Form 1096 (2022)

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