2012 Draft Form 10 Payments From Qualified Education Programs (Under Sectio

3131

Version A, Cycle 3
Dimensions: 7.3" x 3.75"; .5" head margin to top rule

VOID

CORRECTED

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

1 Gross distribution

2011

$
2 Earnings

Form 1099-Q

$
PAYER’S/TRUSTEE'S federal identification no. RECIPIENT’S social security number

3 Basis

4 Trustee-to-trustee
transfer

$
RECIPIENT’S name

5 Check one:
• Qualified tuition program—
Private

Street address (including apt. no.)

OMB No. 1545-1760

6 Check if the recipient is
not the designated
beneficiary

• Coverdell ESA

Account number (see instructions)

Cat. No. 32223J

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.

or State

City, state, and ZIP code

Form 1099-Q

2012

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

DRAFT AS OF
March 5, 2011

Version A, Cycle 3
Dimensions: 7.3" x 3.75"; .5" head margin to top rule

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

1 Gross distribution

2 Earnings

Form 1099-Q

$
3 Basis

4 Trustee-to-trustee
transfer

$
RECIPIENT’S name

2012

2011

$

PAYER’S/TRUSTEE'S federal identification no. RECIPIENT’S social security number

OMB No. 1545-1760

5 Check one:
• Qualified tuition program—
Private

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

or State

Street address (including apt. no.)

• Coverdell ESA

City, state, and ZIP code

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

(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

DRAFT AS OF
March 5, 2011

Version A, Cycle 3
Dimensions: 7.3" x 3.75"; .5" head margin to top rule

2012
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.

2012
2011
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.

DRAFT AS OF
March 5, 2011

Version A, Cycle 3
Dimensions: 7.3" x 3.75"; .5" head margin to top rule

VOID

CORRECTED

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

1 Gross distribution

2 Earnings

Form 1099-Q

$
3 Basis

4 Trustee-to-trustee
transfer

$
RECIPIENT’S name

5 Check one:
• Qualified tuition program—
Private

Street address (including apt. no.)

6 Check if the recipient is
not the designated
beneficiary

or State

• Coverdell ESA

City, state, and ZIP code

Account number (see instructions)
Form 1099-Q

2012

2011

$

PAYER’S/TRUSTEE'S federal identification no. RECIPIENT’S social security number

OMB No. 1545-1760

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

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

Department of the Treasury - Internal Revenue Service

DRAFT AS OF
March 5, 2011

2012

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.

Version A, Cycle 3
Dimensions: 7.3" x 3.75"; .5" head margin to top rule

2013
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.

1, 2013

2013

DRAFT AS OF
March 5, 2011