Form 1099-INT Interest Income

TLS, have you
transmitted all R
text files for this
cycle update?

Page 1 of 6 of Form 1099-INT (Page 2 is Blank)

5

Action

Separation 1: Red

Signature

O.K. to print
Responsible
scan organization

Separation 1 for page 1 of Form 1099-INT. Prints in
Red (J-6983) Ink.
Separation 2 for page 1 of Form 1099-INT. Prints in Black Ink.

Date

Date

O.K. to print
T:FP:F

The type and rule above prints on all proofs including departmental
reproduction proofs. MUST be removed before printing.

Revised proofs
requested

Separation 2: Black
Cumulative changes

9292

VOID

CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no.

Payer’s RTN (optional)

OMB No. 1545-0112

2010

1 Interest income

$

Interest Income

2 Early withdrawal penalty

$
PAYER’S federal identification number

RECIPIENT’S identification number

Form

1099-INT

3 Interest on U.S. Savings Bonds and Treas. obligations

$
4 Federal income tax withheld

5 Investment expenses

$

$

Street address (including apt. no.)

6 Foreign tax paid

7 Foreign country or U.S. possession

City, state, and ZIP code

8 Tax-exempt interest

RECIPIENT’S name

$
$
Account number (see instructions)

9

Specified private activity bond interest

$

2nd TIN not. 10a Tax credit bond credits

10b Code

Copy A
For
Internal Revenue
Service Center
File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2010 General
Instructions for
Certain Information
Returns.

$
Form

1099-INT

Cat. No. 14410K

Department of the Treasury - Internal Revenue Service

f
o
s
a
9
t
0
f
0
a
2
r
/
D /16
7
0

Do Not Cut or Separate Forms on This Page

—

Do Not Cut or Separate Forms on This Page

Page 3 of 6 of Form 1099-INT

5

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

CORRECTED (if checked)
PAYER’S name, street address, city, state, ZIP code, and telephone no.

Payer’s RTN (optional)

1 Interest income

$

OMB No. 1545-0112

2010

Interest Income

2 Early withdrawal penalty

$
PAYER’S federal identification number

RECIPIENT’S identification number

Form

1099-INT

3 Interest on U.S. Savings Bonds and Treas. obligations

$

RECIPIENT’S name

f
o
s
a
9
t
0
f
0
a
2
r
/
D /16
7
0
4 Federal income tax withheld

$

Street address (including apt. no.)

6 Foreign tax paid

City, state, and ZIP code

8 Tax-exempt interest

$

$

Account number (see instructions)

10a Tax credit bond credits

$

Form

1099-INT

(keep for your records)

Copy B
For Recipient

5 Investment expenses

This is important tax
information and is
being furnished to the
Internal Revenue
$
Service. If you are
7 Foreign country or U.S. possession
required to file a return,
a negligence penalty or
other sanction may be
9 Specified private activity bond interest
imposed on you if this
income is taxable and
$
the IRS determines that
10b Code
it has not been
reported.
Department of the Treasury - Internal Revenue Service

Page 4 of 6 of Form 1099-INT

5

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Recipient
Account number. May show an account or other unique number the payer
assigned to distinguish your account.
Box 1. Shows taxable interest paid to you during the calendar year by the
payer. This does not include interest shown in box 3. May also show the total
amount of the credits from clean renewable energy bonds, Gulf tax credit
bonds, qualified forestry conservation bonds, new clean renewable energy
bonds, qualified energy conservation bonds, qualified zone academy bonds,
Midwestern tax credit bonds, qualified school construction bonds, and build
America bonds that must be included in your interest income. These amounts
were treated as paid to you during 2010 on the credit allowance dates (March
15, June 15, September 15, and December 15). For more information, see
Form 8912, Credit to Holders of Tax Credit Bonds.
Box 2. Shows interest or principal forfeited because of early withdrawal of time
savings. You may deduct this amount to figure your adjusted gross income on
your income tax return. See the instructions for Form 1040 to see where to
take the deduction.
Box 3. Shows interest on U.S. Savings Bonds, Treasury bills, Treasury bonds,
and Treasury notes. This may or may not all be taxable. See Pub. 550. This
interest is exempt from state and local income taxes. This interest is not included in box 1.
Box 4. Shows backup withholding. Generally, a payer must backup withhold at
a 28% rate if you did not furnish your taxpayer identification number (TIN) or
you did not furnish the correct TIN to the payer. See Form W-9. Include this
amount on your income tax return as tax withheld.
Box 5. Any amount shown is your share of investment expenses of a singleclass REMIC. If you file Form 1040, you may deduct these expenses on the
“Other expenses” line of Schedule A (Form 1040) subject to the 2% limit. This
amount is included in box 1.

Box 6. Shows foreign tax paid. You may be able to claim this tax as a deduction or a credit on your Form 1040. See your Form 1040 instructions.
Box 8. Shows tax-exempt interest, including exempt-interest dividends from a
mutual fund or other regulated investment company, paid to you during the
calendar year by the payer. Report this amount on line 8b of Form 1040 or
Form 1040A. This amount may be subject to backup withholding. See box 4.
Box 9. Shows tax-exempt interest subject to the alternative minimum tax. This
amount is included in box 8. See the Instructions for Form 6251.
Box 10a. Shows your total share of credits from tax credit bonds distributed
to you and included in box 1.
Box 10b. The codes for tax credit bond types shown in box 10a are: BA–Build
America bond; CR–Clean renewable energy bond; GT–Gulf tax credit bond;
MT–Midwestern tax credit bond; NC–New clean renewable energy bond;
QE–Qualified energy conservation bond; QF–Qualified forestry conservation
bond; QS–Qualified school construction bond; and QZ–Qualified zone
academy bond.
Nominees. If this form includes amounts belonging to another person(s), you
are considered a nominee recipient. Complete a Form 1099-INT for each of
the other owners showing the income allocable to each. File Copy A of the
form with the IRS. Furnish Copy B to each owner. List yourself as the “payer”
and the other owner(s) as the “recipient.” File Form(s) 1099-INT with Form
1096 with the Internal Revenue Service Center for your area. On Form 1096 list
yourself as the “filer.” A husband or wife is not required to file a nominee
return to show amounts owned by the other.

f
o
s
a
9
t
0
f
0
a
2
r
/
D /16
7
0

Page 5 of 6 of Form 1099-INT

5

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

VOID

CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no.

Payer’s RTN (optional)

OMB No. 1545-0112

2010

1 Interest income

$

Interest Income

2 Early withdrawal penalty

f
o
s
a
9
t
0
f
0
a
2
r
/
D /16
7
0
$

PAYER’S federal identification number

RECIPIENT’S identification number

Form

1099-INT

3 Interest on U.S. Savings Bonds and Treas. obligations

$

RECIPIENT’S name

Street address (including apt. no.)

4 Federal income tax withheld

5 Investment expenses

$

$

6 Foreign tax paid

7 Foreign country or U.S. possession

$

City, state, and ZIP code

8 Tax-exempt interest

$

Account number (see instructions)

2nd TIN not. 10a Tax credit bond credits

9

Specified private activity bond interest

$

Copy C
For Payer
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2010 General
Instructions for
Certain Information
Returns.

10b Code

$

Form

1099-INT

Department of the Treasury - Internal Revenue Service

Page 6 of 6 of Form 1099-INT

5

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Payers
General and specific form instructions are provided as
separate products. The products you should use to complete
Form 1099-INT are the 2010 General Instructions for Certain
Information Returns and the 2010 Instructions for Forms
1099-INT and 1099-OID. To order these instructions and
additional forms, visit the IRS website at www.irs.gov, or call
1-800-TAX-FORM (1-800-829-3676).
Caution: Because paper forms are scanned during
processing, you cannot file with the IRS Forms 1096, 1098,
1099, 3921, 3922, or 5498 that you print from the IRS
website.
Due dates. Furnish Copy B of this form to the recipient by
January 31, 2011.
File Copy A of this form with the IRS by February 28, 2011.
If you file electronically, the due date is March 31, 2011. To
file electronically, you must have software that generates a
file according to the specifications in Pub. 1220,
Specifications for Filing Forms 1098, 1099, 3921, 3922, 5498,
8935, and W-2G Electronically. IRS does not provide a fill-in
form option.

Forms 1099-INT and 1098. If you received mortgage interest
in the course of your trade or business, you may have to
report it to the payer of such mortgage interest and to the
IRS on Form 1098, Mortgage Interest Statement. Do not
report mortgage interest to the payer on Form 1099-INT. See
the instructions for Form 1098 for information on reporting
mortgage interest.

f
o
s
a
9
t
0
f
0
a
2
r
/
D /16
7
0

Foreign recipient. If the recipient is a nonresident alien, you
may have to withhold federal income tax and file Form
1042-S, Foreign Person’s U.S. Source Income Subject to
Withholding. See the Instructions for Form 1042-S and Pub.
515, Withholding of Tax on Nonresident Aliens and Foreign
Entities.

Need help? If you have questions about reporting on Form
1099-INT, call the information reporting customer service site
toll free at 1-866-455-7438 or 304-263-8700 (not toll free).
For TTY/TDD equipment, call 304-579-4827 (not toll free).
The hours of operation are Monday through Friday from
8:30 a.m. to 4:30 p.m., Eastern time.

IRS - OMB REVIEW REQUEST FORM
Request for OMB review of currently approved document:
Date:

(Continued)

Name: Janice Y. Martin

07/28/2009

Office Symbols: SE:W:CAR:MP:T:I:P
Phone Number:

Additional Information:

2

202-283-2640

SUPPORTING STATEMENT
1. CIRCUMSTANCES NECESSITATING COLLECTION OF INFORMATION

2. USE OF DATA

3. USE OF IMPROVED INFORMATION TECHNOLOGY TO REDUCE BURDEN

4. EFFORTS TO IDENTIFY DUPLICATION

5. METHODS TO MINIMIZE BURDEN ON SMALL BUSINESSES OR OTHER SMALL ENTITIES

6. CONSEQUENCES OF LESS FREQUENT COLLECTION ON FEDERAL PROGRAMS OR
POLICY ACTIVITIES

Form 14029 (Rev. 4-2009) Catalog Number 51944B Page 4

Department of the Treasury–Internal Revenue Service

7. SPECIAL CIRCUMSTANCES REQUIRING DATA COLLECTION TO BE INCONSISTENT
WITH GUIDELINES IN 5 CFR 1320.5(d)(2)

8. CONSULTATION WITH INDIVIDUALS OUTSIDE OF THE AGENCY ON AVAILABILITY
OF DATA, FREQUENCY OF COLLECTION, CLARITY OF INSTRUCTIONS AND FORMS,
AND DATA ELEMENTS

9. EXPLANATION OF DECISION TO PROVIDE ANY PAYMENT OR GIFT TO RESPONDENTS

10. ASSURANCE OF CONFIDENTIALITY OF RESPONSES

11. JUSTIFICATION OF SENSITIVE QUESTIONS

12. ESTIMATED BURDEN OF INFORMATION COLLECTION

Form 14029 (Rev. 4-2009) Catalog Number 51944B

Page 5

Department of the Treasury–Internal Revenue Service

13. ESTIMATED TOTAL ANNUAL COST BURDEN TO RESPONDENTS

14. ESTIMATED ANNUALIZED COST TO THE FEDERAL GOVERNMENT

15. REASONS FOR CHANGE IN BURDEN

16. PLANS FOR TABULATION, STATISTICAL ANALYSIS AND PUBLICATION

17. REASONS WHY DISPLAYING THE OMB EXPIRATION DATE IS INAPPROPRIATE

18. EXCEPTIONS TO THE CERTIFICATION STATEMENT ON OMB PRA SUBMISSION FORM

19. REASON FOR EMERGENCY SUBMISSION

Form 14029 (Rev. 4-2009) Catalog Number 51944B

Page 6

Department of the Treasury–Internal Revenue Service