Form 1099-Q Payments From Qualified Education Programs (Under Sectio

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3131

VOID

CORRECTED

PAYER’S/TRUSTEE’S name, street address, city, state, ZIP code, and telephone number

1

Gross distribution

$
2

2011

Earnings

$
PAYER’S/TRUSTEE’S federal identification no.

RECIPIENT’S social security number

3

Form

5

4 Trustee-to-trustee
transfer

Check one:

6 Check if the recipient is
not the designated
beneficiary

● Qualified tuition program—

Private

or State

● Coverdell ESA

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form

1099-Q

Cat. No. 32223J

Do Not Cut or Separate Forms on This Page

1099-Q

Basis

$
RECIPIENT’S name

OMB No. 1545-1760

—

Payments From
Qualified
Education
Programs
(Under Sections
529 and 530)
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain Information
Returns.

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

CORRECTED (if checked)
PAYER’S/TRUSTEE’S name, street address, city, state, ZIP code, and telephone number

1

Gross distribution

2011

$
2

Earnings

$
PAYER’S/TRUSTEE’S federal identification no.

RECIPIENT’S social security number

3

Form
Basis

5

Check one:

● Qualified tuition program—

Private
Street address (including apt. no.)

City, state, and ZIP code

or State

1099-Q

6 If this box is checked,
the recipient is not
the designated
beneficiary

● Coverdell ESA
If the fair market value (FMV) is shown below, see Pub. 970,
Tax Benefits for Education, for how to figure earnings.

Account number (see instructions)

Form

1099-Q

4 Trustee-to-trustee
transfer

$
RECIPIENT’S name

OMB No. 1545-1760

(keep for your records)

Payments From
Qualified
Education
Programs
(Under Sections
529 and 530)
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 negligence
penalty or other
sanction may be
imposed on you if this
income is taxable and
the IRS determines
that it has not been
reported.

Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Account number. May show an account or other unique number the payer
has assigned to distinguish your account.
Box 1. Shows the gross distribution (including in-kind distributions) paid to you
this year from a qualified tuition program (QTP), under section 529, or a
Coverdell ESA (CESA), under section 530. This amount is the total of the
amounts shown in box 2 and box 3. See Pub. 970 for more information.
Caution: For CESA distributions (other than earnings on excess contributions)
made during 2011, the payer/trustee is not required to report amounts in boxes
2 and 3. Instead, the payer/trustee may report the fair market value of the CESA
as of December 31, 2011, in the blank box below boxes 5 and 6. To figure your
earnings and basis, use the Coverdell ESA—Taxable Distributions and Basis
worksheet in Pub. 970.
Box 2. Shows the earnings part of the gross distribution shown in box 1.
Generally, amounts distributed are included in income unless they are used to
pay for qualified education expenses, transferred between trustees, or rolled
over to another qualified education program within 60 days. Report taxable
amounts as “Other Income” on Form 1040.
Under a QTP, the amount in box 2 is included in income if there has been
(a) more than one transfer or rollover within any 12-month period with respect
to the same beneficiary, or (b) a change in the designated beneficiary and the
new designated beneficiary is not a family member.

Under a CESA, the amount in box 2 is included in income if there has been
a change in the designated beneficiary and the new designated beneficiary is
not a family member or is over age 30 (except for beneficiaries with special
needs).
Also, an additional 10% tax may apply to part or all of any amount included
in income from the CESA or QTP. See Form 5329 and your tax return
instructions for more information.
If a final (total) distribution is made from your account and you have not
recovered your contributions, see Pub. 970 to determine if you have a
deductible loss and how to claim it.
Box 3. Shows your basis in the gross distribution reported in box 1.
Box 4. This box is checked if a trustee-to-trustee transfer was made from one
QTP to another QTP, from one CESA to another CESA, or from a CESA to a
QTP. However, in certain transfers from a CESA, the box will be blank.
Box 5. Shows whether the gross distribution was from a QTP (private or state)
or from a CESA.
Distribution codes. For 2011, the payer/trustee may, but is not required to,
report (in the box below boxes 5 and 6) one of the following codes to identify
the distribution you received: 1—Distributions (including transfers); 2—Excess
contributions plus earnings taxable in 2011; 3—Excess contributions plus
earnings taxable in 2010; 4—Disability; 5—Death;
6—Prohibited transaction. Note: Nontaxable distributions from CESAs and
QTPs, including rollovers, are not required to be reported on your income tax
return. See Pub. 970 for more information.

VOID

CORRECTED

PAYER’S/TRUSTEE’S name, street address, city, state, ZIP code, and telephone number

1

Gross distribution

OMB No. 1545-1760

2011

$
2

Earnings

$
PAYER’S/TRUSTEE’S federal identification no.

RECIPIENT’S social security number

3

Form
Basis

4

$
RECIPIENT’S name

5

Check one:
Private

City, state, and ZIP code

Account number (see instructions)

Form

1099-Q

Copy C
For Payer

● Qualified tuition program—

Street address (including apt. no.)

1099-Q

Trustee-to-trustee
transfer

Payments From
Qualified
Education
Programs
(Under Sections
529 and 530)

or State

● Coverdell ESA

6

Check if the recipient is
not the designated
beneficiary

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain
Information
Returns.

Department of the Treasury - Internal Revenue Service

Instructions for Payer/Trustee
General and specific form instructions are provided
as separate products. The products you should use
to complete Form 1099-Q are the 2011 General
Instructions for Certain Information Returns and the
2011 Instructions for Form 1099-Q. A chart in the
general instructions gives a quick guide to which form
must be filed to report a particular payment. To order
these instructions and additional forms, visit 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,
1097, 1098, 1099, 3921, 3922, or 5498 that you
download from the IRS website.
Due dates. Furnish Copy B of this form to the
recipient by January 31, 2012.

File Copy A of this form with the IRS by
February 28, 2012. If you file electronically, the due
date is April 2, 2012. To file electronically, you must
have software that generates a file according to the
specifications in Pub. 1220, Specifications for Filing
Forms 1097, 1098, 1099, 3921, 3922, 5498, 8935, and
W-2G Electronically. IRS does not provide a fill-in form
option.
Need help? If you have questions about reporting on
Form 1099-Q, 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.