Form 1099-INT Interest Income

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar
to the official IRS form. Do not file copy A downloaded from this website. The official
printed version of this IRS form is scannable, but the online version of it, printed from
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about printing these tax forms.

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

$
RECIPIENT’S name

4 Federal income tax withheld

5 Investment expenses

$

$

Copy A
For
Internal Revenue
Service Center
File with Form 1096.

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form

1099-INT

For Privacy Act and
7 Foreign country or U.S. possession Paperwork Reduction
Act Notice, see the
2010 General
$
Instructions for
8 Tax-exempt interest
9 Specified private activity bond interest
Certain Information
Returns.
$
$
2nd TIN not. 10 Tax-exempt bond CUSIP no. (see instructions)
6 Foreign tax paid

Cat. No. 14410K

Do Not Cut or Separate Forms on This Page

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

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

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form

1099-INT

Copy B
For Recipient

This is important tax
information and is being
furnished to the Internal
Revenue Service. If you are
$
$
required to file a return, a
6 Foreign tax paid
7 Foreign country or U.S. possession negligence penalty or other
sanction may be imposed
$
on you if this income is
taxable and the IRS
8 Tax-exempt interest
9 Specified private activity bond interest
determines that it has not
been reported.
$
$
10 Tax-exempt bond CUSIP no. (see instructions)
4 Federal income tax withheld

(keep for your records)

5 Investment expenses

Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Recipient’s identification number. For your protection, this form may show
only the last four digits of your social security number (SSN), individual
taxpayer identification number (ITIN), or adoption taxpayer identification
number (ATIN). However, the issuer has reported your complete identification
number to the IRS and, where applicable, to state and/or local governments.
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 10. Shows CUSIP number(s) for tax-exempt bond(s) on which tax-exempt
interest was paid to you during the calendar year and reported in box 8. If
blank, no CUSIP number was issued for the bond(s).
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.

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

$
RECIPIENT’S name

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

9

$

$

$

Account number (see instructions)

Form

1099-INT

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.

2nd TIN not. 10 Tax-exempt bond CUSIP no. (see instructions)

Department of the Treasury - Internal Revenue Service

Instructions for Payer
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.
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.