Form 1099-R Distributions From Pensions, Annuities, Retirement or Pr

Distributions From Pensions, Annuities, Retirement or Profit- Sharing Plans, IRAs, Insurance Contracts, etc.

2012 Form 1099-R and Draft Instructions

Distributions From Pensions, Annuities, Retirement or Profit- Sharing Plans, IRAs, Insurance Contracts, etc.

OMB: 1545-0119

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1545-0119 can be found here:

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9898

VOID

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

CORRECTED

PAYER’S name, street address, city, state, and ZIP code

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

Total
distribution

3 Capital gain (included
in box 2a)

$
/Designated Roth
contributions or
insurance premiums

withheld

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

6 Net unrealized
appreciation in
employer’s securities

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2012 General
Instructions for
Certain
Information
Returns.

7 Distribution
code(s)

Street address (including apt. no.)

4 Federal income tax

5 Employee contributions

RECIPIENT’S name

1099-R

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

IRA/
SEP/
SIMPLE

8 Other

$
9a Your percentage of total

City, state, and ZIP code

distribution

10 Amount allocable to IRR
within 5 years

11 1st year of desig. Roth contrib. 12 State tax withheld

13 State/Payer’s state no. 14 State distribution

$
$

15 Local tax withheld

Account number (see instructions)

$
$
1099-R

$
$

Form

%
9b Total employee contributions

17 Local distribution

$
$

Cat. No. 14436Q

Do Not Cut or Separate Forms on This Page

16 Name of locality

Department of the Treasury - Internal Revenue Service

—

Do Not Cut or Separate Forms on This Page

DRAFT AS OF
September 14, 2011

VOID

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

CORRECTED

PAYER’S name, street address, city, state, and ZIP code

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

Total
distribution

3 Capital gain (included
in box 2a)

$
/Designated Roth
contributions or
insurance premiums

$
Street address (including apt. no.)

4 Federal income tax
withheld

Copy 1
For
State, City,
or Local
Tax Department

5 Employee contributions

RECIPIENT’S name

1099-R

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

6 Net unrealized
appreciation in
employer’s securities

7 Distribution
code(s)

IRA/
SEP/
SIMPLE

8 Other

$
City, state, and ZIP code

9a Your percentage of total
distribution

10 Amount allocable to IRR
within 5 years

$
Account number (see instructions)

11 1st year of desig. Roth contrib. 12 State tax withheld

1099-R

$
13 State/Payer’s state no. 14 State distribution

$
$
15 Local tax withheld

$
$
Form

%
9b Total employee contributions

$
$
16 Name of locality

17 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT AS OF
September 14, 2011

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

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

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

3 Capital gain (included
in box 2a)

Report this
income on your
federal tax
return. If this
form shows
federal income
tax withheld in
box 4, attach
this copy to
your return.

4 Federal income tax
withheld

5 Employee contributions
/Designated Roth
contributions or
insurance premiums

$
Street address (including apt. no.)

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

6 Net unrealized
appreciation in
employer’s securities

7 Distribution
code(s)

IRA/
SEP/
SIMPLE

8 Other

This information is
being furnished to
the Internal
Revenue Service.

$
City, state, and ZIP code

9a Your percentage of total
distribution

10 Amount allocable to IRR
within 5 years

$
Account number (see instructions)

11 1st year of desig. Roth contrib. 12 State tax withheld

1099-R

13 State/Payer’s state no. 14 State distribution

$
$
15 Local tax withheld

$
$
Form

%
9b Total employee contributions

$
$
16 Name of locality

17 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT AS OF
September 14, 2011

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

Instructions for Recipient
Generally, distributions from pensions, annuities, profit-sharing and
retirement plans (including section 457 state and local government
plans), IRAs, insurance contracts, etc., are reported to recipients on
Form 1099-R.
Qualified plans. If your annuity starting date is after 1997, you must
use the simplified method to figure your taxable amount if your payer
did not show the taxable amount in box 2a. See the instructions for
Form 1040 or 1040A.
IRAs. For distributions from a traditional individual retirement
arrangement (IRA), simplified employee pension (SEP), or savings
incentive match plan for employees (SIMPLE), generally the payer is
not required to compute the taxable amount. See the Form 1040 or
1040A instructions to determine the taxable amount. If you are at least
age 70½, you must take minimum distributions from your IRA (other
than a Roth IRA). If you do not, you may be subject to a 50% excise
tax on the amount that should have been distributed. See Pub. 590 for
more information on IRAs.
Roth IRAs. For distributions from a Roth IRA, generally the payer is
not required to compute the taxable amount. You must compute any
taxable amount on Form 8606. An amount shown in box 2a may be
taxable earnings on an excess contribution.
Loans treated as distributions. If you borrow money from a qualified
plan, section 403(b) plan, or governmental section 457(b) plan, you
may have to treat the loan as a distribution and include all or part of
the amount borrowed in your income. There are exceptions to this
rule. If your loan is taxable, Code L will be shown in box 7. See
Pub. 575.
Recipient's identifiction number. For your protection, this form may
show only the last four digits of your SSN, ITIN, or 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 the total amount you received this year. The
amount may have been a direct rollover, a transfer or conversion
to a Roth IRA, a recharacterized IRA contribution; or you may
have received it as periodic payments, as nonperiodic payments,

or as a total distribution. Report the amount on Form 1040 or 1040A
on the line for “IRA distributions” or “Pensions and annuities” (or the
line for “Taxable amount”), and on Form 8606, as applicable.
However, if this is a lump-sum distribution, see Form 4972. If you have
not reached minimum retirement age, report your disability payments
on the line for “Wages, salaries, tips, etc.” on your tax return. Also
report on that line permissible withdrawals from eligible automatic
contribution arrangements and corrective distributions of excess
deferrals, excess contributions, or excess aggregate contributions
except if you are self-employed.
If a life insurance, annuity, qualified long-term care, or endowment
contract was transferred tax free to another trustee or contract issuer,
an amount will be shown in this box and Code 6 will be shown in box
7. If a charge or payment was made against the cash value of an
annuity contract or the cash surrender value of a life insurance
contract for the purchase of qualified long-term care insurance, an
amount will be shown in this box and Code W will be shown in box 7.
You need not report these amounts on your tax return.
Box 2a. This part of the distribution is generally taxable. If there is no
entry in this box, the payer may not have all the facts needed to figure
the taxable amount. In that case, the first box in box 2b should be
checked. You may want to get one of the free publications from the
IRS to help you figure the taxable amount. See Additional information
on the back of Copy 2. For an IRA distribution, see IRAs and Roth
IRAs on this page. For a direct rollover, other than from a qualified
plan to a Roth IRA, zero should be shown, and you must enter zero
(-0-) on the “Taxable amount” line of your tax return.

(Continued on the back of Copy C.)

DRAFT AS OF
September 14, 2011

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

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

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

Total
distribution

3 Capital gain (included
in box 2a)

$
/Designated Roth
contributions or
insurance premiums

For Recipient's
Records

4 Federal income tax
withheld

6 Net unrealized
appreciation in
employer’s securities

7 Distribution
code(s)

Street address (including apt. no.)

Copy C

5 Employee contributions

RECIPIENT’S name

1099-R

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

IRA/
SEP/
SIMPLE

8 Other

This information is
being furnished to
the Internal
Revenue Service.

$
9a Your percentage of total

City, state, and ZIP code

distribution

10 Amount allocable to IRR
within 5 years

11 1st year of desig. Roth contrib. 12 State tax withheld

15 Local tax withheld

Account number (see instructions)

$
$
1099-R

13 State/Payer’s state no. 14 State distribution

$
$

Form

%
9b Total employee contributions

(keep for your records)

$
$
16 Name of locality

17 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT AS OF
September 14, 2011

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

Instructions for Recipient (Continued)
If this is a total distribution from a qualified plan and you were born
before January 2, 1936 (or you are the beneficiary of someone born
before January 2, 1936), you may be eligible for the 10-year tax
option. See the Form 4972 instructions for more information.
If you are an eligible retired public safety officer who elected to
exclude from income distributions from your eligible plan used to pay
certain insurance premiums, the amount shown in box 2a has not
been reduced by the exclusion amount. See the instructions for Form
1040 or Form 1040A for more information.
Box 2b. If the first box is checked, the payer was unable to determine
the taxable amount, and box 2a should be blank, except for an IRA. If
the second box is checked, the distribution was a total distribution
that closed out your account.
Box 3. If you received a lump-sum distribution from a qualified plan
and were born before January 2, 1936 (or you are the beneficiary of
someone born before January 2, 1936), you may be able to elect to
treat this amount as a capital gain on Form 4972 (not on Schedule D
(Form 1040)). See the Form 4972 instructions. For a charitable gift
annuity, report as a long-term capital gain as explained in the
instructions for Schedule D.
Box 4. Shows federal income tax withheld. Include this amount on
your income tax return as tax withheld, and if box 4 shows an amount
(other than zero), attach Copy B to your return. Generally, if you will
receive payments next year that are not eligible rollover distributions,
you can change your withholding or elect not to have income tax
withheld by giving the payer Form W-4P.
Box 5. Generally, this shows the employee’s investment in the
contract (after-tax contributions), if any, recovered tax free this year;
the portion that is your basis in a designated Roth account; the part of
premiums paid on commercial annuities or insurance contracts
recovered tax free; or the nontaxable part of a charitable gift annuity.
This box does not show any IRA contributions. If the amount shown is
your basis in a designated Roth account, the year you first made
contributions to that account may be entered in box 11.

Box 6. If you received a lump-sum distribution from a qualified plan
that includes securities of the employer’s company, the net unrealized
appreciation (NUA) (any increase in value of such securities while in
the trust) is taxed only when you sell the securities unless you choose
to include it in your gross income this year. See Pub. 575 and the
Form 4972 instructions. If you did not receive a lump-sum distribution,
the amount shown is the NUA attributable to employee contributions,
which is not taxed until you sell the securities.
Box 7. The following codes identify the distribution you received. For
more information on these distributions, see the instructions for your
tax return. Also, certain distributions may be subject to an additional
10% tax. See the instructions for Form 5329.
1—Early distribution, no known exception (in most cases, under age
59½).
2—Early distribution, exception applies (under age 59½).
3—Disability.
4—Death.
5—Prohibited transaction.
6—Section 1035 exchange (a tax-free exchange of life insurance,
annuity, qualified long-term care insurance, or endowment
contracts).
7—Normal distribution.
8—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2012.
9—Cost of current life insurance protection.
A—May be eligible for 10-year tax option (see Form 4972).
B—Designated Roth account distribution.
Note. If Code B is in box 7 and an amount is reported in box 10,
see the instructions for Form 5329.
(Continued on the back of Copy 2.)

DRAFT AS OF
September 14, 2011

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

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

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

Total
distribution

3 Capital gain (included
in box 2a)

$
/Designated Roth
contributions or
insurance premiums

$
Street address (including apt. no.)

Copy 2
File this copy
with your state,
city, or local
income tax
return, when
required.

4 Federal income tax
withheld

5 Employee contributions

RECIPIENT’S name

1099-R

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

6 Net unrealized
appreciation in
employer’s securities

7 Distribution
code(s)

IRA/
SEP/
SIMPLE

8 Other

$
City, state, and ZIP code

9a Your percentage of total
distribution

10 Amount allocable to IRR
within 5 years

$
Account number (see instructions)

11 1st year of desig. Roth contrib. 12 State tax withheld

1099-R

$
13 State/Payer’s state no. 14 State distribution

$
$
15 Local tax withheld

$
$
Form

%
9b Total employee contributions

$
$
16 Name of locality

17 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT AS OF
September 14, 2011

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

Instructions for Recipient (Continued)

E—Distributions under Employee Plans Compliance Resolution
System (EPCRS).
F—Charitable gift annuity.
G—Direct rollover of a distribution (other than a designated Roth
account distribution) to a qualified plan, a section 403(b) plan, a
governmental section 457(b) plan, or an IRA.
H—Direct rollover of a designated Roth account distribution to a Roth
IRA.
J—Early distribution from a Roth IRA, no known exception (in most
cases, under age 59½).
L—Loans treated as distributions.
N—Recharacterized IRA contribution made for 2012 and
recharacterized in 2012.
P—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2011.
Q—Qualified distribution from a Roth IRA.
R—Recharacterized IRA contribution made for 2011 and
recharacterized in 2012.
S—Early distribution from a SIMPLE IRA in first 2 years, no known
exception (under age 59½).
T—Roth IRA distribution, exception applies.
U—Dividend distribution from ESOP under sec. 404(k).
Note. This distribution is not eligible for rollover.
W—Charges or payments for purchasing qualified long-term care
insurance contracts under combined arrangements.
If the IRA/SEP/SIMPLE box is checked, you have received a
traditional IRA, SEP, or SIMPLE distribution.
Box 8. If you received an annuity contract as part of a distribution, the
value of the contract is shown. It is not taxable when you receive it and
should not be included in boxes 1 and 2a. When you receive periodic
payments from the annuity contract, they are taxable at that time. If
the distribution is made to more than one person, the percentage of the
annuity contract distributed to you is also shown. You will need this
information if

you use the 10-year tax option (Form 4972). If charges were made for
qualified long-term care insurance contracts under combined
arrangements, the amount of the reduction in the investment (but not
below zero) in the annuity or life insurance contract is reported here.
Box 9a. If a total distribution was made to more than one person, the
percentage you received is shown.
Box 9b. For a life annuity from a qualified plan or from a section 403
(b) plan (with after-tax contributions), an amount may be shown for the
employee’s total investment in the contract. It is used to compute the
taxable part of the distribution. See Pub. 575.
Box 10. If an amount is reported in this box, see the instructions for
Form 5329.
Box 11. The 1st year you made a contribution to the designated Roth
account reported on this form is shown in this box.
Boxes 12—17. If state or local income tax was withheld from the
distribution, boxes 14 and 17 may show the part of the distribution
subject to state and/or local tax.
Additional information. You may want to see:
Form W-4P, Withholding Certificate for Pension or Annuity Payments,
Form 4972, Tax on Lump-Sum Distributions,
Form 5329, Additional Taxes on Qualified Plans (Including IRAs) and
Other Tax-Favored Accounts,
Form 8606, Nondeductible IRAs,
Pub. 560, Retirement Plans for Small Business (SEP, SIMPLE, and
Qualified Plans),
Pub. 571, Tax-Sheltered Annuity Plans (403(b) Plans),
Pub. 575, Pension and Annuity Income,
Pub. 590, Individual Retirement Arrangements (IRAs),
Pub. 721, Tax Guide to U.S. Civil Service Retirement Benefits,
Pub. 939, General Rule for Pensions and Annuities,
Pub. 969, Health Savings Accounts and Other Tax-Favored Health
Plans.

DRAFT AS OF
September 14, 2011

VOID

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

CORRECTED

PAYER’S name, street address, city, state, and ZIP code

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

Total
distribution

3 Capital gain (included
in box 2a)

$
/Designated Roth
contributions or
insurance premiums

$
Street address (including apt. no.)

Copy D
For Payer

4 Federal income tax
withheld

5 Employee contributions

RECIPIENT’S name

1099-R

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

6 Net unrealized
appreciation in
employer’s securities

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2012 General
Instructions for
Certain
Information
Returns.

7 Distribution
code(s)

IRA/
SEP/
SIMPLE

8 Other

$
City, state, and ZIP code

9a Your percentage of total
distribution

10 Amount allocable to IRR
within 5 years

$
Account number (see instructions)

11 1st year of desig. Roth contrib. 12 State tax withheld

1099-R

13 State/Payer’s state no. 14 State distribution

$
$
15 Local tax withheld

$
$
Form

%
9b Total employee contributions

$
$
16 Name of locality

17 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT AS OF
September 14, 2011

Version A, Cycle 3
Image Dimensions: 7.3" x 5.1"

Instructions for Payer
We provide general and specific form
instructions as separate products. The
products you should use to complete Form
1099-R are the 2012 General Instructions for
Certain Information Returns and the 2012
Instructions for Forms 1099-R and 5498. 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 print from the IRS website.
Due dates. Furnish Copies B, C, and 2 of this
form to the recipient by January 31, 2013.

File Copy A of this form with the IRS by
February 28, 2013. If you file electronically, the
due date is April 2, 2013. 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-R, 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.

DRAFT AS OF
September 14, 2011

12/ 2011

Department of the Treasury
Internal Revenue Service

Instructions for Forms
1099-R and 5498
Section references are to the Internal Revenue Code unless
otherwise noted.

What’s New
Pilot program for truncating an individual’s
identifying number on paper payee statements has
ended. Filers of Forms 1099-R and 5498 must show the
recipient’s (Form 1099-R) and participant’s (Form 5498)
complete identifying number on all copies of the forms.
Truncating recipient/participant identification

number on paper payee statements. Notice 2011-38
Form
1099-R
allows filers of forms 1099-R and 5498 to truncate a

recipient's (Form 1099-R)
or participant's
(Form
5498) 15 have
Renumbering
of boxes.
Boxes 10
through
identification
number (social
security
(SSN),
been
renumbered
as boxes
12number
through
17, respectively.
individual
taxpayer
identification
number
or box 10 has
The
blank
box formerly
to the
left (ITIN),
of former
adoption
taxpayer identification
number
(ATIN)) onallocable
paper
been
numbered
and labeled
“10 Amount
to IRR
within
5 years” and
a years
dollar2011
sign
($)
has See
been
payee statements
for tax
and
2012.
partadded. The
box
yearGeneral
of desig.
Roth contrib.”
M in “1st
the 2012
Instructions
for Certainhas been numbered
11.
Information Returns.
Prohibited transactions. Information regarding
identifying and reporting prohibited transactions relating
to an IRA has been added to Specific Instructions for
Form 1099-R.
Reporting excess employer contributions returned to
an employer. Instructions for reporting excess employer
contributions (plus earnings on them) returned to an
employer have been added to Distributions under
Employee Plans Compliance Resolution System
(EPCRS).
Rollovers to designated Roth accounts within the
same plan (in-plan Roth rollovers). Instructions for
reporting in-plan Roth rollovers that are direct rollovers
have been added to Designated Roth accounts starting
on page 4 and the instructions for boxes 1 and 2a. Also,
for more information on in-plan Roth rollovers, see Notice
2010-84.
Distributions from designated Roth accounts
allocable to in-plan Roth rollovers. Instructions for
reporting distributions from a designated Roth account
allocable to an in-plan Roth rollover have been added to
Designated Roth Account Distributions on pages 2 and 8
and the instructions for new box 10. Also, for more
information on in-plan Roth rollovers, see Notice
2010-84.

Guide to Distribution Chart
Code B. Distribution Code B has been reworded for
reporting all distributions from designated Roth accounts.
Code D. Distribution Code D has been eliminated. See
Distribution Codes 8 and P.

Form 5498
Successor beneficiary reporting. A new paragraph
has been added to the instructions under Inherited IRAs
for reporting successor beneficiary(ies).
Fair market valuation. A Caution has been added to
the instructions for box 5, Fair market value of account.

How to get the latest information. If there are changes to the
2012 tax laws that affect these forms, you can find them at www.irs.gov/form1099r
and www.irs.gov/
form5498.

Reminders

In addition, see the 2011 General Instructions for Certain
Information Returns (Forms 1097, 1098, 1099, 3921,
3922, 5498, and W-2G) for information on the following
topics.
• Backup withholding.
• Electronic reporting requirements.
• Penalties.
• Who must file (nominee/middleman).
• When and where to file.
• Taxpayer identification numbers.
• Statements to recipients.
• Corrected and void returns.
• Other general topics.
You can get the general instructions at IRS.gov or call
1-800-TAX-FORM (1-800-829-3676).

Specific Instructions for Form 1099-R

File Form 1099-R, Distributions From Pensions,
Annuities, Retirement or Profit-Sharing Plans, IRAs,
Insurance Contracts, etc., for each person to whom you
have made a designated distribution or are treated as
having made a distribution of $10 or more from
profit-sharing or retirement plans, any individual
retirement arrangements (IRAs), annuities, pensions,
insurance contracts, survivor income benefit plans,
permanent and total disability payments under life
insurance contracts, charitable gift annuities, etc.
Also, report on Form 1099-R death benefit payments
made by employers that are not made as part of a
pension, profit-sharing, or retirement plan. See Box 1 on
page 8.
Reportable disability payments made from a retirement
plan must be reported on Form 1099-R.
Generally, do not report payments subject to
withholding of social security and Medicare taxes on this
form. Report such payments on Form W-2, Wage and
Tax Statement.
Generally, do not report amounts totally exempt from
tax, such as workers’ compensation and Department of
Veterans Affairs (VA) payments. However, if part of the
distribution is taxable and part is nontaxable, report the
entire distribution.
There is no special reporting for qualified
TIP charitable distributions under section 408(d)(8),
qualified health saving account (HSA) funding
distributions described in section 408(d)(9), or for the
payment of qualified health and long-term care insurance
premiums for retired public safety officers described in
section 402(l).
Military retirement annuities. Report payments to
military retirees or payments of survivor benefit annuities
on Form 1099-R. Report military retirement pay awarded
as a property settlement to a former spouse under the
name and taxpayer identification number (TIN) of the
recipient, not that of the military retiree.
Governmental section 457(b) plans. Report on Form
1099-R, not Form W-2, income tax withholding and
distributions from a governmental section 457(b) plan
maintained by a state or local government employer.

Cat. No. 27987M

12/

Distributions from a governmental section 457(b) plan to
a participant or beneficiary include all amounts that are
paid from the plan. For more information, see Notice
2003-20 which is on page 894 of Internal Revenue
Bulletin 2003-19, at www.irs.gov/pub/irs-irbs/irb03-19.pdf.
Also see Section 457(b) plan distributions on page 12 for
information on distribution codes.
Nonqualified plans. Report any reportable distributions
from commercial annuities. Report distributions to
employee plan participants from section 409A
nonqualified deferred compensation plans including
nongovernmental section 457(b) plans on Form W-2, not
on Form 1099-R; for nonemployees, these payments are
reportable on Form 1099-MISC. Also, report distributions
to beneficiaries of deceased plan participants on Form
1099-MISC.
Section 404(k) dividends. Distributions of section
404(k) dividends from an employee stock ownership plan
(ESOP), including a tax credit ESOP, are reported on
Form 1099-R. Distributions other than section 404(k)
dividends from the plan must be reported on a separate
Form 1099-R.
Section 404(k) dividends paid directly from the
corporation to participants or their beneficiaries are
reported on Form 1099-DIV. See Announcement
2008-56, 2008-26 I.R.B. 1192, available at www.irs.gov/
irb/2008-26_IRB/ar11.html.
Charitable gift annuities. If cash or capital gain
property is donated in exchange for a charitable gift
annuity, report distributions from the annuity on Form
1099-R. See Charitable gift annuities on page 8.
Life insurance, annuity, and endowment contracts.
Report payments of matured or redeemed annuity,
endowment, and life insurance contracts. However, you
do not need to file Form 1099-R to report the surrender of
a life insurance contract if it is reasonable to believe that
none of the payment is includible in the income of the
recipient. If you are reporting the surrender of a life
insurance contract, see Code 7 on page 13.
Report premiums paid by a trustee or custodian for the
cost of current life or other insurance protection. Costs of
current life insurance protection are not subject to the
10% additional tax under section 72(t). See Cost of
current life insurance protection on page 9.
Report charges or payments for a qualified long-term
care insurance contract against the cash value of an
annuity contract or the cash surrender value of a life
insurance contract, which is excludible from gross
income under section 72(e)(11). See Code W on
page 15.
Section 1035 exchange. A tax-free section 1035
exchange is the exchange of (a) a life insurance contract
for another life insurance contract, or for an endowment
or annuity contract, or for a qualified long-term care
insurance contract; or (b) a contract of endowment
insurance for another contract of endowment insurance
that provides for regular payments to begin no later than
they would have begun under the old contract, or for an
annuity contract, or for a qualified long-term care
insurance contract; or (c) an annuity contract for an
annuity contract or for a qualified long-term care
insurance contract; or (d) a qualified long-term care
insurance contract for a qualified long-term care
insurance contract. A contract shall not fail to be treated
as an annuity contract or as a life insurance contract
solely because a qualified long-term care insurance
contract is a part of or a rider on such contract. However,
the distribution of other property or the cancellation of a
contract loan at the time of the exchange may be taxable
and reportable on a separate Form 1099-R.
These exchanges of contracts are generally reportable
on Form 1099-R. However, reporting on Form 1099-R is
not required if (a) the exchange occurs within the same

company, (b) the exchange is solely a contract for
contract exchange, as defined above, that does not result
in a designated distribution, and (c) the company
maintains adequate records of the policyholder’s basis in
the contracts. For example, a life insurance contract
issued by Company X received in exchange solely for
another life insurance contract previously issued by
Company X does not have to be reported on Form
1099-R as long as the company maintains the required
records. See Rev. Proc. 92-26, 1992-1 C.B. 744, for
certain exchanges for which reporting is not required
under section 6047(d). Also see Rev. Rul. 2007-24,
2007-21 I.R.B. 1282, available at www.irs.gov/irb/
2007-21_IRB/ar15.html for certain transactions that do
not qualify as tax-free exchanges. For more information
on partial exchanges of annuity contracts, see Rev. Proc.
2008-24, 2008-13 I.R.B. 684, available at www.irs.gov/
irb/2008-13_IRB/ar13.html.
For more information on reporting taxable exchanges,
see Box 1 on page 8.
Prohibited transactions. If an IRA owner engages in a
prohibited transaction with respect to an IRA, the assets
of the IRA are treated as distributed on the first day of the
tax year in which the prohibited transaction occurs. IRAs
that include, or consist of, non-marketable securities and/
or closely held investments, in which the IRA owner
effectively controls the underlying assets of such
securities or investments, have a greater potential for
resulting in a prohibited transaction. Report the
distribution as you normally would for the type of IRA that
has engaged in the prohibited transaction. Enter Code 5
in box 7.

Designated Roth Account Distributions

An employer offering a section 401(k), 403(b), or
governmental section 457(b) plan may allow participants
to contribute all or a portion of the elective deferrals they
are otherwise eligible to make to a separate designated
Roth account established under the plan. Contributions
made under a section 401(k) plan must meet the
requirements of Regulations section 1.401(k)-1(f)
(Regulations section 1.403(b)-3(c) for a section 403(b)
plan). Under the terms of the section 401(k) plan, section
403(b) plan, or governmental section 457(b) plan, the
designated Roth account must meet the requirements of
section 402A.
Distributions allocable to an in-plan Roth rollover
(IRR). The distribution of an amount allocable to the
taxable amount of an in-plan Roth rollover (IRR), made
within the 5-year period beginning with the first day of the
participant’s tax year in which the rollover was made, is
treated as includible in gross income for purposes of
applying section 72(t) to the distribution. The total amount
allocable to such an IRR is reported in new box 10. See
the instructions for Box 10 on page 13.
A separate Form 1099-R must be used to report
the total annual distribution from a designated
CAUTION Roth account.

IRA Distributions
For deemed IRAs under section 408(q), use the
TIP rules that apply to traditional IRAs or Roth IRAs
as applicable. Simplified employee pension (SEP)
IRAs and savings incentive match plan for employees
(SIMPLE) IRAs, however, may not be used as deemed
IRAs.
Deemed IRAs. A qualified employer plan may allow
employees to make voluntary employee contributions to
a separate account or annuity established under the plan.
Under the terms of the qualified employer plan, the
account or annuity must meet the applicable
requirements of section 408 or 408A for a traditional IRA
or Roth IRA. Under section 408(q), the “deemed IRA”
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Instructions for Forms 1099-R and 5498 (2011) 12/

portion of the qualified employer plan is subject to the
rules applicable to traditional and Roth IRAs, and not to
those of the applicable plan under section 401(a), 403(a),
403(b), or 457.
Accordingly, the reporting and withholding rules on
plan and IRA distributions apply separately depending on
whether the distributions are made from the deemed IRA
or the qualified employer plan. For example, the reporting
rules for required minimum distributions (RMDs) apply
separately for the two portions of the plan. A total
distribution of amounts held in the qualified employer
plan portion and the deemed IRA portion is reported on
two separate Forms 1099-R — one for the distribution
from the deemed IRA portion and one for the rest of the
distribution. Also, the 20% withholding rules of section
3405(c) do not apply to a distribution from the deemed
IRA portion but would apply to a distribution from the
qualified employer plan portion, and section 72(t) applies
separately to the two portions.
IRAs other than Roth IRAs. Unless otherwise
instructed, distributions from any IRA, except a Roth IRA,
must be reported in boxes 1 and 2a. Check the “Taxable
amount not determined” box in box 2b. But see:
• Traditional, SEP, or SIMPLE IRA on page 10 for how
to report the withdrawal of IRA contributions under
section 408(d)(4),
• Transfers on page 5 for information on
trustee-to-trustee transfers, including recharacterizations,
• Reporting a corrective distribution from an IRA under
section 408(d)(5) on page 10,
• Reporting IRA revocations or account closures due to
Customer Identification Program failures, below, and
• Reporting a transfer from a SIMPLE IRA to a
non-SIMPLE IRA within the first 2 years of plan
participation on page 5.

IRA must be reported. In addition, Form 5498, IRA
Contribution Information, must be filed to report any
regular, rollover, Roth IRA conversion, SEP IRA, or
SIMPLE IRA contribution to an IRA that is subsequently
revoked or closed by the trustee or custodian.
If a regular contribution is made to a traditional or Roth
IRA that later is revoked or closed, and distribution is
made to the taxpayer, enter the gross distribution in box
1. If no earnings are distributed, enter 0 (zero) in box 2a
and Code 8 in box 7 for a traditional IRA and Code J for a
Roth IRA. If earnings are distributed, enter the amount of
earnings in box 2a. For a traditional IRA, enter Codes 1
and 8, if applicable, in box 7; for a Roth IRA, enter Codes
J and 8, if applicable. These earnings could be subject to
the 10% early distribution tax under section 72(t). If a
rollover contribution is made to a traditional or Roth IRA
that later is revoked or closed, and distribution is made to
the taxpayer, enter in boxes 1 and 2a of Form 1099-R the
gross distribution and the appropriate code in box 7
(Code J for a Roth IRA). Follow this same procedure for
a transfer from a traditional or Roth IRA to another IRA of
the same type that later is revoked or closed. The
distribution could be subject to the 10% early distribution
tax under section 72(t).
If an IRA conversion contribution or a rollover from a
qualified plan is made to a Roth IRA that later is revoked
or closed, and a distribution is made to the taxpayer,
enter the gross distribution in box 1 of Form 1099-R. If no
earnings are distributed, enter 0 (zero) in box 2a and
Code J in box 7. If earnings are distributed, enter the
amount of the earnings in box 2a and Code J in box 7.
These earnings could be subject to the 10% early
distribution tax under section 72(t).
If an employer SEP IRA or SIMPLE IRA plan
contribution is made and the SEP IRA or SIMPLE IRA is
revoked by the employee or is closed by the trustee or
custodian, report the distribution as fully taxable.
For more information on IRAs that have been revoked,
see Rev. Proc. 91-70, 1991-2 C.B. 899.

The direct rollover provisions beginning later do not apply
to distributions from any IRA. However, taxable
distributions from traditional IRAs and SEP IRAs may be
rolled over into an eligible retirement plan. See section
408(d)(3). SIMPLE IRAs may also be rolled over into an
eligible retirement plan, but only after the 2-year period
described in section 72(t)(6).
An IRA includes all investments under one IRA plan or
account. File only one Form 1099-R for distributions from
all investments under one plan that are paid in 1 year to
one recipient, unless you must enter different codes in
box 7. You do not have to file a separate Form 1099-R
for each distribution under the plan.
Roth IRAs. For distributions from a Roth IRA, report the
gross distribution in box 1 but generally leave box 2a
blank. Check the “Taxable amount not determined” box in
box 2b. Enter Code J, Q, or T as appropriate in box 7. Do
not use any other codes with Code Q or Code T. You
may enter Code 8 or P with Code J. For the withdrawal of
excess contributions, see Roth IRA on page 9. It is not
necessary to mark the IRA/SEP/SIMPLE checkbox.
Roth IRA conversions. You must report a traditional,
SEP, or SIMPLE IRA distribution that you know is
converted or reconverted this year to a Roth IRA in boxes
1 and 2a (checking box 2b “taxable amount not
determined” unless otherwise directed elsewhere in
these instructions), even if the conversion is a
trustee-to-trustee transfer or is with the same trustee.
Enter Code 2 or 7 in box 7 depending on the
participant’s age.

Deductible Voluntary Employee
Contributions (DVECs)

If you are reporting a total distribution from a plan that
includes a distribution of DVECs, file a separate Form
1099-R to report the distribution of DVECs. Report the
distribution of DVECs in boxes 1 and 2a on the separate
Form 1099-R. However, for the direct rollover (explained
later) of funds that include DVECs, a separate Form
1099-R is not required to report the direct rollover of the
DVECs.

Direct Rollovers

You must report a direct rollover of an eligible rollover
distribution. A direct rollover is the direct payment of the
distribution from a qualified plan, section 403(b) plan, or a
governmental section 457(b) plan to a traditional IRA,
Roth IRA, or other eligible retirement plan. For additional
rules regarding the treatment of direct rollovers from
designated Roth accounts, see Designated Roth
accounts on page 4. A direct rollover may be made for
the employee, for the employee’s surviving spouse, for
the spouse or former spouse who is an alternate payee
under a qualified domestic relations order (QDRO) or for
a nonspouse designated beneficiary, in which case the
direct rollover can only be made to an inherited IRA. If
the distribution is paid to the surviving spouse, the
distribution is treated in the same manner as if the
spouse were the employee. See Part V of Notice 2007-7,
2007-5 I.R.B. 395, available at www.irs.gov/irb/
2007-05_IRB/ar11.html, which has been modified by
Notice 2009-82, 2009-41 I.R.B. 491, available at www.irs.
gov/irb/2009-41_IRB/ar12.html for guidance on direct
rollovers by nonspouse designated beneficiaries. See
also Notice 2008-30, Part II, 2008-12 I.R.B. 638,

IRA Revocation or Account Closure

If a traditional or Roth IRA is revoked during its first 7
days (under Regulations section 1.408-6(d)(4)(ii)) or is
closed at any time by the IRA trustee or custodian due to
a failure of the taxpayer to satisfy the Customer
Identification Program requirements described in section
326 of the USA PATRIOT Act, the distribution from the
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Instructions for Forms 1099-R and 5498 (2011)

-3-

available at www.irs.gov/irb/2008-12_IRB/ar11.html,
which has been amplified and clarified by Notice
2009-75, 2009-39 I.R.B. 436, available at www.irs.gov/
irb/2009-39_IRB/ar15.html, for questions and answers
covering rollover contributions to Roth IRAs.
Notice 2007-7 and Notice 2008-30 do not reflect
changes made to section 402 by the Worker,
CAUTION Retiree, and Employer Recovery Act of 2008.
An eligible rollover distribution is any distribution of all
or any portion of the balance to the credit of the
employee (including net unrealized appreciation (NUA))
from a qualified plan, a section 403(b) plan or a
governmental section 457(b) plan except:
1. One of a series of substantially equal periodic
payments made at least annually over:
a. The life of the employee or the joint lives of the
employee and the employee’s designated beneficiary,
b. The life expectancy of the employee or the joint life
and last survivor expectancy of the employee and the
employee’s designated beneficiary, or
c. A specified period of 10 years or more.
2. An RMD (under section 401(a)(9)). A plan
administrator is permitted to assume there is no
designated beneficiary for purposes of determining the
minimum distribution.
3. Elective deferrals (under section 402(g)(3)),
employee contributions, and earnings on each returned
because of the section 415 limits.
4. Corrective distributions of excess deferrals (under
section 402(g)) and earnings.
5. Corrective distributions of excess contributions
under a qualified cash or deferred arrangement (under
section 401(k)) and excess aggregate contributions
(under section 401(m)) and earnings.
6. Loans treated as deemed distributions (under
section 72(p)). But plan loan offset amounts can be
eligible rollover distributions. See Regulations section
1.402(c)-2, Q/A-9.
7. Section 404(k) dividends.
8. Cost of current life insurance protection.
9. Distributions to a payee other than the employee,
the employee’s surviving spouse, a spouse or former
spouse who is an alternate payee under a QDRO, or a
nonspouse designated beneficiary.
10. Any hardship distribution.
11. A permissible withdrawal under section 414(w).
12. Prohibited allocations of securities in an S
corporation that are treated as deemed distributions.
13. Distributions of premiums for accident or health
insurance under Regulations section 1.402(a)-1(e).

than from a designated Roth account. See Qualified
rollover contributions as defined in section 408A(e) on
page 5. You do not have to report capital gain in box 3 or
NUA in box 6. Enter Code G in box 7 unless the rollover
is a direct rollover from a designated Roth account to a
Roth IRA. See Designated Roth accounts below. If the
direct rollover is made by a nonspouse designated
beneficiary, also enter Code 4 in box 7.
Prepare the form using the name and social security
number (SSN) of the person for whose benefit the funds
were rolled over (generally the participant), not those of
the trustee of the traditional IRA or other plan to which
the funds were rolled.
If you receive a direct rollover to an IRA, you must
prepare Form 5498. If you receive a direct rollover to a
qualified plan, section 403(b) plan or a governmental
section 457(b) plan, no report is required.
If part of the distribution is a direct rollover and part is
distributed to the recipient, prepare two Forms 1099-R.
For more information on eligible rollover distributions,
including substantially equal periodic payments, RMDs,
and plan loan offset amounts, see Regulations sections
1.402(c)-2 and 1.403(b)-7(b). Also, see Rev. Rul.
2002-62 which is on page 710 of Internal Revenue
Bulletin 2002-42 at www.irs.gov/pub/irs-irbs/irb02-42.pdf
for guidance on substantially equal periodic payments
that began after December 31, 2002.

Amounts paid under an annuity contract purchased for
and distributed to a participant under a qualified plan can
qualify as eligible rollover distributions. See Regulations
section 1.402(c)-2, Q/A-10.
Automatic rollovers. Eligible rollover distributions may
also include involuntary distributions that are more than
$1,000 but $5,000 or less and are made from a qualified
plan to an IRA on behalf of a plan participant. Involuntary
distributions made on or after March 28, 2005, are
generally subject to the automatic rollover provisions of
section 401(a)(31)(B) and must be paid in a direct
rollover to an IRA, unless the plan participant elects to
receive the distribution directly.
For information on the notification requirements, see
Explanation to Recipients Before Eligible Rollover
Distributions (Section 402(f) Notice) on page 5. For
additional information, also see Notice 2005-5, 2005-3
I.R.B. 337, available at www.irs.gov/irb/2005-03_IRB/
ar10.html.
Reporting a direct rollover. Report a direct rollover in
box 1 and a 0 (zero) in box 2a, unless the rollover is a
direct rollover of a qualified rollover contribution other
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Instructions for Forms 1099-R and 5498 (2011)

12/

For a direct rollover of a distribution from a designated
Roth account to a Roth IRA, enter the amount rolled over
in box 1 and 0 (zero) in box 2a. Use Code H in box 7. For
all other distributions from a designated Roth account,
use code B in box 7, unless code E applies. If the direct
rollover is from one designated Roth account to another
designated Roth account, also enter Code G in box 7.
For a direct rollover of a distribution from a section
401(k) plan, a section 403(b) plan, or a governmental
section 457(b) plan to a designated Roth account in the
same plan, enter the amount rolled over in box 1, the
taxable amount in box 2a, and any basis recovery
amount in box 5. Use Code G in box 7.
Qualified rollover contributions as defined in
section 408A(e). A qualified rollover contribution as
defined in section 408A(e) is:
• A rollover contribution to a Roth IRA from another IRA
that meets the requirements of section 408(d)(3) or
• A rollover contribution to a Roth IRA from an eligible
retirement plan (other than an IRA) that meets the
requirements of section 408A(e)(2)(B).
For reporting a rollover from an IRA other than a Roth
IRA to a Roth IRA, see Roth IRA conversions on pages 3
and 9.
For a direct rollover of an eligible rollover distribution
to a Roth IRA (other than from a designated Roth
account), report the total amount rolled over in box 1, the
taxable amount in box 2a, and any basis recovery
amount in box 5. (See the instructions for Box 5 on page
11.) Use Code G in box 7. If the direct rollover is made
on behalf of a nonspouse designated beneficiary, also
enter Code 4 in box 7.
For reporting instructions for a direct rollover from a
designated Roth account, see Designated Roth
accounts, on page 4.

within the time period described earlier or some other
reasonable period of time.
Notice 2009-68, 2009-39 I.R.B. 423, available at www.
irs.gov/irb/2009-39_IRB/ar14.html, contains two safe
harbor explanations that may be provided to recipients of
eligible rollover distributions from an employer plan in
order to satisfy section 402(f). See also Notice 2009-75,
and, if the plan offers IRRs, Notice 2010-84, Q/A-5,
2010-51 I.R.B. 872, which is available at www.irs.gov/irb/
2010-51_IRB/ar11.html.
Involuntary distributions. For involuntary distributions
paid to an IRA in a direct rollover (automatic rollover) you
may satisfy the notification requirements of section
401(a)(31)(B)(i) either separately or as a part of the
section 402(f) notice. The notification must be in writing
and may be sent using electronic media in accordance
with Q/A-5 of Regulations section 1.402(f)-1. Also see
Notice 2005-5, Q/A-15.

Transfers

Generally, do not report a transfer between trustees or
issuers that involves no payment or distribution of funds
to the participant, including a trustee-to-trustee transfer
from one IRA to another IRA, valid transfers from one
section 403(b) plan in accordance with paragraphs 1
through 3 of Regulations section 1.403(b)-10(b), or for
the purchase of permissive service credit under section
403(b)(13) or section 457(e)(17) in accordance with
paragraph 4 of Regulations section 1.403(b)-10(b) and
Regulations section 1.457-10(b)(8). However, you must
report:
• Recharacterized IRA contributions;
• Roth IRA conversions; and
• Direct rollovers from qualified plans, section 403(b)
plans or governmental section 457(b) plans, including
any direct rollovers from such plans that are qualified
rollover contributions described in section 408A(e).
IRA recharacterizations. You must report each
recharacterization of an IRA contribution. If a participant
makes a contribution to an IRA (first IRA) for a year, the
participant may choose to recharacterize the contribution
by transferring, in a trustee-to-trustee transfer, any part of
the contribution (plus earnings) to another IRA (second
IRA). The contribution is treated as made to the second
IRA (recharacterization). A recharacterization may be
made with the same trustee or with another trustee. The
trustee of the first IRA must report the recharacterization
as a distribution on Form 1099-R and the contribution to
the first IRA and its character on Form 5498.
Enter the fair market value (FMV) of the amount
recharacterized in box 1, 0 (zero) in box 2a, and Code R
in box 7 if reporting a recharacterization of a prior-year
(2010) contribution or Code N if reporting a
recharacterization of a contribution in the same year
(2011). It is not necessary to check the IRA/SEP/SIMPLE
checkbox. For more information on how to report, see
Notice 2000-30 on page 1266 of Internal Revenue
Bulletin 2000-25 at www.irs.gov/pub/irs-irbs/irb00-25.pdf.
Section 1035 exchange. You may have to report
exchanges of insurance contracts, including an exchange
under section 1035, under which any designated
distribution may be made. For a section 1035 exchange
that is in part taxable, file a separate Form 1099-R to
report the taxable amount. See Section 1035 exchange
on page 2.
SIMPLE IRAs. Do not report a trustee-to-trustee
transfer from one SIMPLE IRA to another SIMPLE IRA.
However, you must report as a taxable distribution in
boxes 1 and 2a a trustee-to-trustee transfer from a
SIMPLE IRA to an IRA that is not a SIMPLE IRA during
the 2-year period beginning on the day contributions are
first deposited in the individual’s SIMPLE IRA by the
employer. Use Code S in box 7 if appropriate.

Explanation to Recipients Before Eligible
Rollover Distributions (Section 402(f)
Notice)

For qualified plans, section 403(b) plans, and
governmental section 457(b) plans, the plan
administrator must provide to each recipient of an eligible
rollover distribution an explanation using either a written
paper document or an electronic medium (section 402(f)
notice). The explanation must be provided no more than
90 days (as much as 180 days for plan years that begin
after December 31, 2006) and no fewer than 30 days
before making an eligible rollover distribution or before
the annuity starting date. However, if the recipient who
has received the section 402(f) notice affirmatively elects
a distribution, you will not fail to satisfy the timing
requirements merely because you make the distribution
fewer than 30 days after you provided the notice as long
as you meet the requirements of Regulations section
1.402(f)-1, Q/A-2. The electronic section 402(f) notice
must meet the consumer consent requirements as
provided in Regulations section 1.401(a)-21(b).
The notice must explain the rollover rules, the special
tax treatment for lump-sum distributions, the direct
rollover option (and any default procedures), the
mandatory 20% withholding rules, and an explanation of
how distributions from the plan to which the rollover is
made may have different restrictions and tax
consequences than the plan from which the rollover is
made. The notice and summary are permitted to be sent
either as a written paper document or through an
electronic medium reasonably accessible to the recipient;
see Regulations section 1.402(f)-1, Q/A-5.
For periodic payments that are eligible rollover
distributions, you must provide the notice before the first
payment and at least once a year as long as the
payments continue. For section 403(b) plans, the payer
must provide an explanation of the direct rollover option
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Instructions for Forms 1099-R and 5498 (2011)

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Transfer of an IRA to spouse. If you transfer or
re-designate an interest from one spouse’s IRA to an IRA
for the other spouse under a divorce or separation
instrument, the transfer or re-designation as provided
under section 408(d)(6) is tax free. Do not report such a
transfer on Form 1099-R.

Excess aggregate contributions. Excess aggregate
contributions under section 401(m) can occur in section
401(a), section 401(k), section 403(a), and section 403(b)
plans. A corrective distribution of excess aggregate
contributions plus earnings is taxable to the participant in
the year the distribution was made. Report the gross
distribution in box 1 of Form 1099-R. In box 2a, enter the
excess and earnings distributed less any after-tax
contributions.
Losses. If a corrective distribution of an excess deferral
is made in a year after the year of deferral and a net loss
has been allocated to the excess deferral, report the
corrective distribution amount in boxes 1 and 2a of Form
1099-R for the year of the distribution with the
appropriate distribution code in box 7. If the excess
deferrals consist of designated Roth contributions, report
the corrective distribution amount in box 1, 0 (zero) in box
2a, and the appropriate distribution code in box 7.
However, taxpayers must include the total amount of the
excess deferral (unadjusted for loss) in income in the
year of deferral, and they may report a loss on the tax
return for the year the corrective distribution is made.

Corrective Distributions

You must report on Form 1099-R corrective distributions
of excess deferrals, excess contributions and excess
aggregate contributions under section 401(a) plans,
section 401(k) cash or deferred arrangements, section
403(a) annuity plans, section 403(b) salary reduction
agreements, and salary reduction simplified employee
pensions (SARSEPs) under section 408(k)(6). Excess
contributions that are recharacterized under a section
401(k) plan are treated as distributed. Corrective
distributions must include earnings through the end of the
year in which the excess arose. These distributions are
reportable on Form 1099-R and are generally taxable in
the year of the distribution (except for excess deferrals
under section 402(g)). Enter Code 8 or P in box 7 (with
Code B if applicable) to designate the distribution and the
year it is taxable.
Use a separate Form 1099-R to report a corrective
distribution from a designated Roth account.
The total amount of the elective deferral is
TIP reported in box 12 of Form W-2. See the
Instructions for Forms W-2 and W-3 for more
information.
For more information about reporting corrective
distributions see: the Guide to Distribution Codes on
pages 13 through 15; Notice 89-32, 1989-1 C.B. 671;
Notice 88-33, 1988-1 C.B. 513; Notice 87-77, 1987-2
C.B. 385; and the Regulations under sections 401(k),
401(m), 402(g), and 457.
Excess deferrals. Excess deferrals under section
402(g) can occur in section 401(k) plans or section
403(b) plans or SARSEPs. If distributed by April 15 of the
year following the year of deferral, the excess is taxable
to the participant in the year of deferral (other than
designated Roth contributions), but the earnings are
taxable in the year distributed. Except for a SARSEP, if
the distribution occurs after April 15, the excess is
taxable in the year of deferral and the year distributed.
The earnings are taxable in the year distributed. For a
SARSEP, excess deferrals not withdrawn by April 15 are
considered regular IRA contributions subject to the IRA
contribution limits. Corrective distributions of excess
deferrals are not subject to federal income tax
withholding or social security and Medicare taxes. For
losses on excess deferrals, see Losses, later. See the
regulations under section 457 for special rules for excess
deferrals under governmental section 457(b) plans.
Excess contributions. Excess contributions can occur
in a section 401(k) plan or a SARSEP. All distributions of
the excess contributions plus earnings (other than
designated Roth contributions), including recharacterized
excess contributions, are taxable to the participant in the
year of distribution. Report the gross distribution in box 1
of Form 1099-R. In box 2a, enter the excess contribution
and earnings distributed less any designated Roth
contributions. For a SARSEP, the employer must notify
the participant by March 15 of the year after the year the
excess contribution was made that the participant must
withdraw the excess and earnings. All distributions from a
SARSEP are taxable in the year of distribution. An
excess contribution not withdrawn by April 15 of the year
after the year of notification is considered a regular IRA
contribution subject to the IRA contribution limits.
Regulations have not been updated for
SARSEPs.

Distributions under Employee Plans
Compliance Resolution System (EPCRS)

The procedure for correcting excess annual additions
under section 415 is explained in the latest EPCRS
revenue procedure, Rev. Proc. 2008-50, 2008-35 I.R.B.
464, available at www.irs.gov/irb/2008-35_IRB/ar10.html.
At the time these instructions went to print, a new
EPCRS revenue procedure, which supersedes
CAUTION Rev. Proc. 2008-50, had not been issued. Go to
IRS.gov and type “EPCRS” in the search box to obtain
updated information.
Distributions to correct a section 415 failure are not
eligible rollover distributions although they are subject to
federal income tax withholding under section 3405. They
are not subject to social security, Medicare, or Federal
Unemployment Tax Act (FUTA) taxes. In addition, such
distributions are not subject to the 10% early distribution
tax under section 72(t).
You may report the distribution of elective deferrals
(other than designated Roth contributions) and employee
contributions (and earnings attributable to such elective
deferrals and employee contributions) on the same Form
1099-R. However, if you made other distributions during
the year, report them on a separate Form 1099-R.
Because the distribution of elective deferrals (other than
designated Roth contributions) is fully taxable in the year
distributed (no part of the distribution is a return of the
investment in the contract), report the total amount of the
distribution in boxes 1 and 2a. Leave box 5 blank, and
enter Code E in box 7. For a return of employee
contributions (or designated Roth contributions) plus
earnings, enter the gross distribution in box 1, the
earnings attributable to the employee contributions (or
designated Roth contributions) being returned in box 2a,
and the employee contributions (or designated Roth
contributions) being returned in box 5. Enter Code E in
box 7. For more information, see Rev. Proc. 92-93,
1992-2 C.B. 505.
Similar rules apply to other corrective distributions
under EPCRS. Also, special Form 1099-R reporting is
available for certain plan loan failures. See Rev. Proc.
2008-50 for details.
If excess employer contributions (other than elective
deferrals), and the earnings on them, under SEP,
SARSEP, or SIMPLE IRA plans are returned to an
employer, enter the gross distribution (excess and
earnings) in box 1 and 0 (zero) in box 2a. Enter Code E
in box 7.

CAUTION

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Instructions for Forms 1099-R and 5498 (2011) 12/

12/
13/

12/

withholding. If a distribution occurs after the loan is made,
you must withhold only if you distributed cash or property
(other than employer securities) at the time of the
deemed or actual distribution. See section 72(p), section
72(e)(4)(A), and Regulations section 1.72(p)-1.
Subsequent repayments. If a participant makes any
cash repayments on a loan that was reported on Form
1099-R as a deemed distribution, the repayments
increase the participant’s tax basis in the plan as if the
repayments were after-tax contributions. However, such
repayments are not treated as after-tax contributions for
purposes of section 401(m) or 415(c)(2)(B).
For a deemed distribution that was reported on Form
1099-R but was not repaid, the deemed distribution does
not increase the participant’s basis.
If a participant’s accrued benefit is reduced (offset) to
repay a loan, the amount of the account balance that is
offset against the loan is an actual distribution. Report it
as you would any other actual distribution. Do not enter
Code L in box 7.

Failing the ADP or ACP Test After a Total
Distribution

If you make a total distribution in 2011 and file a Form
1099-R with the IRS and then discover in 2012 that the
plan failed either the section 401(k)(3) actual deferral
percentage (ADP) test for 2011 and you compute excess
contributions or the section 401(m)(2) actual contribution
percentage (ACP) test and you compute excess
aggregate contributions, you must recharacterize part of
the total distribution as excess contributions or excess
aggregate contributions. First, file a CORRECTED Form
1099-R for 2011 for the correct amount of the total
distribution (not including the amount recharacterized as
excess contributions or excess aggregate contributions).
Second, file a new Form 1099-R for 2011 for the excess
contributions or excess aggregate contributions and
allocable earnings.
To avoid a late filing penalty if the new Form 1099-R is
filed after the due date, enter in the bottom margin of
Form 1096, Annual Summary and Transmittal of U.S.
Information Returns, the words “Filed To Correct Excess
Contributions.”
You must also issue copies of the Forms 1099-R to
the plan participant with an explanation of why these new
forms are being issued. ADP and ACP test corrections
are exempt from the 10% early distribution tax under
section 72(t).

Permissible Withdrawals Under Section
414(w)

For permissible withdrawals from an eligible automatic
contribution arrangement (EACA) under section 414(w):
• The distribution (except to the extent the distribution
consists of designated Roth contributions) is included in
the employee’s gross income in the year distributed;
• Report principal and earnings in boxes 1 and 2a
except, in the case of a distribution from a designated
Roth account, report only earnings in box 2a;
• The distribution is not subject to the 10% additional
tax, indicated by reporting Distribution Code 2 in box 7;
and
• The distribution must be elected by the employee no
later than 90 days after the first default elective
contribution under the EACA, as specified in Regulations
section 1.414(w)-1(c)(2).
If the distribution is from a designated Roth account,
enter Code B as well as Code 2 in box 7.

Loans Treated as Distributions

A loan from a qualified plan under sections 401(a) and
403(a) and (b), and a plan maintained by the United
States, a state or political subdivision, or any of its
subsidiary agencies made to a participant or beneficiary
is not treated as a distribution from the plan if the loan
satisfies the following requirements.
1. The loan is evidenced by an enforceable
agreement,
2. The agreement specifies that the loan must be
repaid within 5 years, except for a principal residence,
3. The loan must be repaid in substantially level
installments (at least quarterly), and
4. The loan amount does not exceed the limits in
section 72(p)(2)(A) (maximum limit is equal to the lesser
of 50% of the vested account balance or $50,000).

Missing Participants

The IRS administers a letter-forwarding program that
could help plan administrators contact missing retirement
plan participants (or possibly their beneficiaries). To
inform individuals of their rights to benefits under a
retirement plan, the IRS will forward letters from plan
administrators to the missing individuals if the
administrators provide the names and SSNs of the
missing individuals. However, the IRS cannot disclose
individuals’ addresses or give confirmation of letter
delivery. All undelivered letters will be destroyed. For
further information, see Rev. Proc. 94-22, 1994-1 C.B.
608, or contact your IRS office.

Certain exceptions, cure periods, and suspension of
the repayment schedule may apply.
The loan agreement must specify the amount of the
loan, the term of the loan, and the repayment schedule.
The agreement may include more than one document.
If a loan fails to satisfy 1, 2, or 3, the balance of the
loan is a deemed distribution. The distribution may occur
at the time the loan is made or later if the loan is not
repaid in accordance with the repayment schedule.
If a loan fails to satisfy 4 at the time the loan is made,
the amount that exceeds the amount permitted to be
loaned is a deemed distribution.
Deemed distribution. If a loan is treated as a deemed
distribution, it is reportable on Form 1099-R using the
normal taxation rules of section 72, including tax basis
rules. The distribution also may be subject to the 10%
early distribution tax under section 72(t). It is not eligible
to be rolled over to an eligible retirement plan nor is it
eligible for the 10-year tax option. On Form 1099-R,
complete the appropriate boxes, including boxes 1 and
2a, and enter Code L in box 7. Also, enter Code 1 or
Code B, if applicable.
Interest that accrues after the deemed distribution of a
loan is not an additional loan, and, therefore, is not
reportable on Form 1099-R.
Loans that are treated as deemed distributions or that
are actual distributions are subject to federal income tax
12/

Instructions for Forms 1099-R and 5498 (2011)

Corrected Form 1099-R

If you filed a Form 1099-R with the IRS and later discover
that there is an error on it, you must correct it as soon as
possible. For example, if you transmit a direct rollover
and file a Form 1099-R with the IRS reporting that none
of the direct rollover is taxable by entering 0 (zero) in box
2a, and you then discover that part of the direct rollover
consists of RMDs under section 401(a)(9), you must file a
corrected Form 1099-R reporting the eligible rollover
distribution as the direct rollover and file a new Form
1099-R reporting the RMD as if it had been distributed to
the participant. See part H in the 2011 General
Instructions for Certain Information Returns or Pub. 1220,
if filing electronically.

Filer

The payer, trustee, or plan administrator must file Form
1099-R using the same name and employer identification
number (EIN) used to deposit any tax withheld and to file
-7-

12/

Form 945, Annual Return of Withheld Federal Income
Tax.

rollovers, IRA rollovers to accepting employer plans,
premiums paid by a trustee or custodian for the cost of
current life or other insurance protection, including a
recharacterization and a Roth IRA conversion. Also
include in this box distributions to plan participants from
governmental section 457(b) plans. However, in the case
of a distribution by a trust representing certificates of
deposit (CDs) redeemed early, report the net amount
distributed. Also, see Box 6 on page 12.
Include in this box the value of U.S. Savings Bonds
distributed from a plan. Enter the appropriate taxable
amount in box 2a. Furnish a statement to the plan
participant showing the value of each bond at the time of
distribution. This will provide him or her with the
information necessary to figure the interest income on
each bond when it is redeemed.
Include in box 1 amounts distributed from a qualified
retirement plan for which the recipient elects to pay
health insurance premiums under a cafeteria plan or that
are paid directly to reimburse medical care expenses
incurred by the recipient (see Rev. Rul. 2003-62 on page
1034 of Internal Revenue Bulletin 2003-25 at www.irs.
gov/pub/irs-irbs/irb03-25.pdf). Also include this amount in
box 2a.
Include in box 1 charges or payments for qualified
long-term care insurance contracts under combined
arrangements. Enter Code W in box 7.
In addition to reporting distributions to beneficiaries of
deceased employees, report here any death benefit
payments made by employers that are not made as part
of a pension, profit-sharing, or retirement plan. Also enter
these amounts in box 2a; enter Code 4 in box 7.
Do not report accelerated death benefits on Form
1099-R. Report them on Form 1099-LTC,
CAUTION Long-Term Care and Accelerated Death Benefits.
For section 1035 exchanges that are reportable on
Form 1099-R, enter the total value of the contract in box
1, 0 (zero) in box 2a, the total premiums paid in box 5,
and Code 6 in box 7.
Designated Roth account distributions. If you are
making a distribution from a designated Roth account,
enter the gross distribution in box 1, the taxable portion of
the distribution in box 2a, the basis included in the
distributed amount in box 5, any amount allocable to an
IRR made within the previous 5 years in box 10, and the
first year of the 5-taxable-year period for determining
qualified distributions in box 11. Also, enter the applicable
code(s) in box 7.
Employer securities and other property. If you
distribute employer securities or other property, include in
box 1 the FMV of the securities or other property on the
date of distribution. If there is a loss, see Losses on
page 9.
If you are distributing worthless property only, you are
not required to file Form 1099-R. However, you may file
and enter 0 (zero) in boxes 1 and 2a and any after-tax
employee contributions or designated Roth contributions
in box 5.
Charitable gift annuities. If cash or capital gain
property is donated in exchange for a charitable gift
annuity, report the total amount distributed during the
year in box 1. See Charitable gift annuities under Box 3
on page 10.

Beneficiaries

If you make a distribution to a beneficiary, trust, or estate,
prepare Form 1099-R using the name and TIN of the
beneficiary, trust, or estate, not that of the decedent. If
there are multiple beneficiaries, report on each Form
1099-R only the amount paid to the beneficiary whose
name appears on the Form 1099-R, and enter the
percentage in box 9a, if applicable.
Disclaimers. A beneficiary may make a qualified
disclaimer of all or some of an IRA account balance if the
disclaimed amount and income are paid to a new
beneficiary or segregated in a separate account. A
qualified disclaimer may be made after the beneficiary
has previously received the RMD for the year of the
decedent’s death. For more information, see Rev. Rul.
2005-36, 2005-26 I.R.B. 1368, available at www.irs.gov/
irb/2005-26_IRB/ar11.html.

Alternate Payee under a Qualified Domestic
Relations Order (QDRO)

Distributions to an alternate payee who is a spouse or
former spouse of the employee under a QDRO are
reportable on Form 1099-R using the name and TIN of
the alternate payee. If the alternate payee under a QDRO
is a nonspouse, enter the name and TIN of the
employee. However, this rule does not apply to IRAs; see
Transfer of an IRA to spouse on page 6.

Nonresident Aliens

12/

If income tax is withheld under section 3405 on any
distribution to a nonresident alien, report the distribution
and withholding on Form 1099-R. Also file Form 945 to
report the withholding. See the Presumption Rules in part
S of the 2011 General Instructions for Certain Information
Returns.
However, any payments to a nonresident alien from
any trust under section 401(a), any annuity plan under
section 403(a), any annuity, custodial account, or
retirement income account under section 403(b), or any
IRA account under section 408(a) or (b) are subject to
withholding under section 1441, unless there is an
exception under a tax treaty. Report the distribution and
withholding on Form 1042, Annual Withholding Tax
Return for U.S. Source Income of Foreign Persons, and
Form 1042-S, Foreign Person’s U.S. Source Income
Subject to Withholding.
For guidance regarding covered expatriates, see
Notice 2009-85, 2009-45 I.R.B. 598, available at www.irs.
gov/irb/2009-45_IRB/ar10.html.

Statements to Recipients
12/

If you are required to file Form 1099-R, you must furnish
a statement to the recipient. For more information about
the requirement to furnish a statement to each recipient,
see part M in the 2011 General Instructions for Certain
Information Returns.
Do not enter a negative amount in any box on
TIP Form 1099-R.

Account Number

12/

The account number is required if you have multiple
accounts for a recipient for whom you are filing more than
one Form 1099-R. Additionally, the IRS encourages you
to designate an account number for all Forms 1099-R
that you file. See part L in the 2011 General Instructions
for Certain Information Returns.

Box 2a. Taxable amount
When determining the taxable amount to be
entered in box 2a, do not reduce the taxable
CAUTION amount by any portion of the $3,000 exclusion for
which the participant may be eligible as a payment of
qualified health and long-term care insurance premiums
for retired public safety officers under section 402(l).

Box 1. Gross distribution

Enter the total amount of the distribution before income
tax or other deductions were withheld. Include direct
-8-

Instructions for Forms 1099-R and 5498 (2011) 12/

Generally, you must enter the taxable amount in box
2a. However, if you are unable to reasonably obtain the
data needed to compute the taxable amount, leave this
box blank. Do not enter excludable or tax-deferred
amounts reportable in boxes 5, 6, and 8. Enter 0 (zero) in
box 2a for:
• A direct rollover (other than a qualified rollover
contribution under section 408A(e) or an IRR) from a
qualified plan, section 403(b) plan, a governmental
section 457(b) plan, or a rollover from a designated Roth
account into a Roth IRA,
• A traditional, SEP, or SIMPLE IRA directly transferred
to an accepting employer plan,
• An IRA recharacterization,
• A nontaxable section 1035 exchange of life insurance,
annuity, endowment or long-term care insurance
contracts, or
• A nontaxable charge or payment, for the purchase of a
qualified long-term care insurance contract, against the
cash value of an annuity contract or the cash surrender
value of a life insurance contract.
For more information on qualified rollover contributions
under section 408A(e), see Qualified rollover
contributions as defined in section 408A(e) on page 5.
Annuity starting date in 1998 or later. If you made
annuity payments from a qualified plan under section
401(a), 403(a), or 403(b) and the annuity starting date is
in 1998 or later, you must use the simplified method
under section 72(d)(1) to figure the taxable amount.
Under this method, the expected number of payments
you use to figure the taxable amount depends on
whether the payments are based on the life of one or
more than one person. See Notice 98-2, 1998-1 C.B.
266, and Pub. 575, Pension and Annuity Income, to help
you figure the taxable amount to enter in box 2a.
Annuity starting date after November 18, 1996, and
before 1998. Under the simplified method for figuring
the taxable amount, the expected number of payments is
based only on the primary annuitant’s age on the annuity
starting date. See Notice 98-2.
Annuity starting date before November 19, 1996. If
you properly used the rules in effect before November
19, 1996, for annuities that started before that date,
continue to report using those rules. No changes are
necessary.
Corrective distributions. Enter in box 2a the amount of
excess deferrals, excess contributions, or excess
aggregate contributions (other than employee
contributions or designated Roth contributions). See
Corrective Distributions on page 6.
Cost of current life insurance protection. Include
current life insurance protection costs (net premium
costs) that were reported in box 1. However, do not
report these costs and a distribution on the same Form
1099-R. Use a separate Form 1099-R for each. For the
cost of current life insurance protection, enter Code 9 in
box 7.
DVECs. Include DVEC distributions in this box. Also see
Deductible Voluntary Employee Contributions (DVECs)
on page 3.
Designated Roth account. Generally, a distribution
from a designated Roth account that is not a qualified
distribution is taxable to the recipient under section 402 in
the case of a plan qualified under section 401(a), under
section 403(b)(1) in the case of a section 403(b) plan and
under section 457(a)(1)(B) in the case of a governmental
section 457(b) plan. For purposes of section 72,
designated Roth contributions are treated as employer
contributions as described in section 72(f)(1) (that is, as
includible in the participant’s gross income).
Examples. Participant A received a nonqualified
distribution of $5,000 from the participant’s designated
Roth account. Prior to the distribution, the participant’s
12/

Instructions for Forms 1099-R and 5498 (2011)

account balance was $10,000, consisting of $9,400 of
designated Roth contributions and $600 of earnings. The
taxable amount of the $5,000 distribution is $300 ($600/
$10,000 x $5,000). The nontaxable portion of the
distribution is $4,700 ($9,400/$10,000 x $5,000). The
issuer would report on Form 1099-R:
• Box 1, $5,000 as the gross distribution;
• Box 2a, $300 as the taxable amount;
• Box 4, $60 ($300 x 20%) as the withholding on the
earnings portion of the distribution;
• Box 5, $4,700 as the designated Roth contribution
basis (nontaxable amount);
• Box 7, Distribution Code B; and
• The first year of the 5-taxable-year period in box 11.
Using the same facts as in the example above, except
that the distribution was a direct rollover to a Roth IRA,
the issuer would report on Form 1099-R:
• Box 1, $5,000 as the gross distribution;
• Box 2a, 0 (zero) as the taxable amount;
• Box 4, no entry;
• Box 5, $4,700 as the designated Roth contribution
basis (nontaxable amount);
• Box 7, Distribution Code H; and
• The first year of the 5-taxable-year period in box 11.
Losses. If a distribution is a loss, do not enter a
negative amount in this box. For example, if stock is
distributed from a profit-sharing plan but the value is less
than the employee’s after-tax contributions or designated
Roth contributions, enter the value of the stock in box 1,
leave box 2a blank, and enter the employee’s
contributions or designated Roth contributions in box 5.
For a plan with no after-tax contributions or designated
Roth contributions, even though the value of the account
may have decreased, there is no loss for reporting
purposes. Therefore, if there are no employer securities
distributed, show the actual cash and/or FMV of property
distributed in boxes 1 and 2a, and make no entry in box
5. If only employer securities are distributed, show the
FMV of the securities in boxes 1 and 2a and make no
entry in box 5 or 6. If both employer securities and cash
or other property are distributed, show the actual cash
and/or FMV of the property (including employer
securities) distributed in box 1, the gross less any NUA
on employer securities in box 2a, no entry in box 5, and
any NUA in box 6.
Qualified rollover contributions. See Direct Rollovers
on page 3 for information on qualified rollover
contributions.
Roth IRA. For a distribution from a Roth IRA, report the
total distribution in box 1 and leave box 2a blank except
in the case of an IRA revocation or account closure (see
page 3) and a recharacterization (see page 5). Use Code
J, Q, or T as appropriate in box 7. Use Code 8 or P, if
applicable, in box 7 with Code J. Do not combine Code Q
or T with any other codes.
However, for the distribution of excess Roth IRA
contributions, report the gross distribution in box 1 and
only the earnings in box 2a. Enter Code J and Code 8 or
P in box 7.
Roth IRA conversions. Report the total amount
converted or reconverted from a traditional IRA, SEP
IRA, or SIMPLE IRA to a Roth IRA in box 2a. Check the
“Taxable amount not determined” box in box 2b. A
conversion or reconversion is considered a distribution
and must be reported even if it is with the same trustee
and even if the conversion is done by a trustee-to-trustee
transfer. When an individual retirement annuity described
in section 408(b) is converted to a Roth IRA, the amount
that is treated as distributed is the FMV of the annuity
contract on the date the annuity contract is converted.
This rule also applies when a traditional IRA holds an
annuity contract as an account asset and the traditional
IRA is converted to a Roth IRA. Determining the FMV of
-9-

an individual retirement annuity issued by a company
regularly engaged in the selling of contracts depends on
the timing of the conversion as outlined in Q/A-14 of
Regulations section 1.408A-4.
For a Roth IRA conversion, use Code 2 in box 7 if the
participant is under age 591/2 or Code 7 if the participant
is at least age 591/2. Also check the IRA/SEP/SIMPLE
box in box 7.
Traditional, SEP, or SIMPLE IRA. Generally, you are
not required to compute the taxable amount of a
traditional, SEP, or SIMPLE IRA nor designate whether
any part of a distribution is a return of basis attributable to
nondeductible contributions. Therefore, except as
provided below or elsewhere in these instructions, report
the total amount distributed from a traditional, SEP, or
SIMPLE IRA in box 2a. This will be the same amount
reported in box 1. Check the “Taxable amount not
determined” box in box 2b.
However, for a distribution by a trust representing CDs
redeemed early, report the net amount distributed. Do not
include any amount paid for IRA insurance protection in
this box.
For a distribution of contributions plus earnings from
an IRA before the due date of the return under section
408(d)(4), report the gross distribution in box 1, only the
earnings in box 2a, and enter Code 8 or P, whichever is
applicable, in box 7. Enter Code 1 or 4 also, if applicable.
For a distribution of excess contributions without
earnings after the due date of the individual’s return
under section 408(d)(5), leave box 2a blank, and check
the “Taxable amount not determined” checkbox in box
2b. Use Code 1 or 7 in box 7 depending on the age of the
participant.
For a traditional IRA or a SEP IRA directly rolled over
to an accepting employer plan, or a SIMPLE IRA directly
rolled over to an accepting employer plan after the 2-year
period (see section 72(t)(6)), enter the gross amount in
box 1, 0 (zero) in box 2a, and Code G in box 7.

Reconciliation Act of 2001. Enter the full amount eligible
for the capital gain election. You should not complete this
box for a direct rollover.
To compute the months of an employee’s active
participation before 1974, count as 12 months any part of
a calendar year in which an employee actively
participated under the plan; for active participation after
1973, count as 1 month any part of a month in which the
employee actively participated under the plan. See the
Example, below.
Active participation begins with the first month in which
an employee became a participant under the plan and
ends with the earliest of:
• The month in which the employee received a
lump-sum distribution under the plan;
• For an employee, other than a self-employed person or
owner-employee, the month in which the employee
separates from service;
• The month in which the employee dies; or
• For a self-employed person or owner-employee, the
first month in which the employee becomes disabled
within the meaning of section 72(m)(7).

C. Total of lines 1 through 3

XXXXX

Box 2b. Taxable amount not determined

D. Total taxable amount. Subtract line C
from line A.

XXXXX

Example for Computing Amount Eligible
for Capital Gain Election (See Box 3.)
Step 1. Total Taxable Amount
A. Total distribution
B. Less:
1. Current actuarial value of any annuity
2. Employee contributions or designated
Roth contributions (minus any amounts
previously distributed that were not
includible in the employee’s gross income)
3. Net unrealized appreciation in the value
of any employer securities that was a part
of the lump-sum distribution.

Enter an “X” in this box only if you are unable to
reasonably obtain the data needed to compute the
taxable amount. If you check this box, leave box 2a
blank; but see Traditional, SEP, or SIMPLE IRA, above.
Except for IRAs, make every effort to compute the
taxable amount.

XXXXX
XXXX

XXXX
XXXX

Step 2. Capital Gain
Total taxable
amount
Line D

Box 2b. Total distribution

Enter an “X” in this box only if the payment shown in box
1 is a total distribution. A total distribution is one or more
distributions within 1 tax year in which the entire balance
of the account is distributed. If periodic or installment
payments are made, mark this box in the year the final
payment is made.

Months of active
participation before
1974
_____________________= Capital gain
Total months of active
participation

Box 4. Federal income tax withheld

Enter any federal income tax withheld. This withholding
under section 3405 is subject to deposit rules and the
withholding tax return is Form 945. Backup withholding
does not apply. See Pub. 15-A, Employer’s Supplemental
Tax Guide, and the Instructions for Form 945 for more
withholding information.
Even though you may be using Code 1 in box 7 to
designate an early distribution subject to the 10%
additional tax specified in section 72(q), (t), or (v), you
are not required to withhold that tax.

Box 3. Capital gain (included in box 2a)

If any amount is taxable as a capital gain, report it in
box 3.
Charitable gift annuities. Report in box 3 any amount
from a charitable gift annuity that is taxable as a capital
gain. Report in box 1 the total amount distributed during
the year. Report in box 2a the taxable amount. Advise
the annuity recipient of any amount in box 3 subject to
the 28% rate gain for collectibles and any unrecaptured
section 1250 gain. Report in box 5 any nontaxable
amount. Enter Code F in box 7. See Regulations section
1.1011-2(c), Example 8.
Special rule for participants born before January 2,
1936 (or their beneficiaries). For lump-sum
distributions from qualified plans only, enter the amount
in box 2a eligible for the capital gain election under
section 1122(h)(3) of the Tax Reform Act of 1986 and
section 641(f)(3) of the Economic Growth and Tax Relief

The amount withheld cannot be more than the
TIP sum of the cash and the FMV of property
(excluding employer securities) received in the
distribution. If a distribution consists solely of employer
securities and cash ($200 or less) in lieu of fractional
shares, no withholding is required.
To determine your withholding requirements for any
designated distribution under section 3405, you must first
determine whether the distribution is an eligible rollover
distribution. See Direct Rollovers on page 3 for a
-10-

Instructions for Forms 1099-R and 5498 (2011)

12/

Instructions for Forms 1099-R and 5498 (2011)

Rather than Form W-4P, military retirees should
TIP give you Form W-4, Employee’s Withholding
Allowance Certificate.
Nonperiodic distributions. Withhold 10% of the
taxable part of a nonperiodic distribution that is not an
eligible rollover distribution. In most cases, designated
distributions from any IRA are treated as nonperiodic
distributions subject to withholding at the 10% rate even if
the distributions are paid over a periodic basis. See
Regulations section 35.3405-1T, Q/A F-14. The recipient
may request additional withholding on Form W-4P or
claim exemption from withholding.
Failure to provide TIN. For periodic payments and
nonperiodic distributions, if a payee fails to furnish his or
her correct TIN to you in the manner required, or if the
IRS notifies you before any distribution that the TIN
furnished is incorrect, a payee cannot claim exemption
from withholding. For periodic payments, withhold as if
the payee was single claiming no withholding allowances.
For nonperiodic payments, withhold 10%. Backup
withholding does not apply.

Box 5. Employee contributions/designated
Roth contributions or insurance premiums

Enter the employee’s contributions to a profit-sharing or
retirement plan, designated Roth contributions, or
insurance premiums that the employee may recover tax
free this year (even if they exceed the box 1 amount).
The entry in box 5 may include any of the following: (a)
designated Roth contributions or contributions actually
made on behalf of the employee over the years under the
retirement or profit-sharing plan that were required to be
included in the income of the employee when contributed
(after-tax contributions), (b) contributions made by the
employer but considered to have been contributed by the
employee under section 72(f), (c) the accumulated cost
of premiums paid for life insurance protection taxable to
the employee in previous years and in the current year
under Regulations section 1.72-16 (cost of current life
insurance protection) (only if the life insurance contract
itself is distributed), and (d) premiums paid on
commercial annuities. Do not include contributions to any
DVEC, section 401(k) plan, or any other contribution to a
retirement plan that was not an after-tax contribution.
Generally, for qualified plans, section 403(b) plans,
and nonqualified commercial annuities, enter in box 5 the
employee contributions or insurance premiums recovered
tax free during the year based on the method you used to
determine the taxable amount to be entered in box 2a.
On a separate Form 1099-R, include the portion of the
employee’s basis that has been distributed from a
designated Roth account. See the Examples in the
instructions for box 2a on page 9.
If periodic payments began before 1993, you are not
required to, but you are encouraged to, report in box 5.
If you made periodic payments from a qualified
plan and the annuity starting date is after
CAUTION November 18, 1996, you must use the simplified
method to figure the tax-free amount each year. See
Annuity starting date in 1998 or later on page 9.
If a total distribution is made, the total employee
contributions or insurance premiums available to be
recovered tax free must be shown only in box 5. If any
previous distributions were made, any amount recovered
tax free in prior years must not appear in box 5.
If you are unable to reasonably obtain the data
necessary to compute the taxable amount, leave boxes
2a and 5 blank, and check the first box in box 2b.
For more information, see Rev. Proc. 92-86, 1992-2
C.B. 495 and section 72(d).
For reporting charitable gift annuities, see Charitable
gift annuities on page 10.

-11-

For further guidance on what makes a series of
substantially equal periodic payments, see Notice
CAUTION 89-25, Q/A-12, as modified by Rev. Rul. 2002-62,
2002-42 I.R.B. 710. Notice 2004-15, 2004-9 I.R.B. 526,
available at www.irs.gov/irb/2004-09_IRB/ar09.html,
allows taxpayers to use one of three methods in Notice
89-25, as modified by Rev. Rul. 2002-62, to determine
whether a distribution from a nonqualified annuity is part
of a series of substantially equal periodic payments under
section 72(q)(2)(D).
If part of an eligible rollover distribution is paid in a
direct rollover and part is not, you must file a separate
Form 1099-R for each part showing the appropriate code
on each form. If part of a distribution is an eligible rollover
distribution and part is not (for example, a minimum
distribution required by section 401(a)(9)) and the part
that is an eligible rollover distribution is directly rolled
over, you must file a separate Form 1099-R to report
each part.
Section 457(b) plan distributions. Generally, a
distribution from a governmental section 457(b) plan is
not subject to the 10% additional tax under section 72(t).
However, an early distribution from a governmental
section 457(b) plan of an amount that is attributable to a
rollover from another type of eligible retirement plan or
IRA is subject to the additional tax as if the distribution
were from a plan described in section 401(a). See
section 72(t)(9). If the distribution consists solely of
amounts that are not attributable to such a rollover, enter
Code 2 in box 7. If the distribution consists solely of
amounts attributable to such a rollover, then enter the
appropriate code in box 7 as if the distribution were from
a plan described in section 401(a). If the distribution is
made up of amounts from both sources, you must file
separate Forms 1099-R for each part of the distribution
unless Code 2 would be entered on each form.

Box 6. Net unrealized appreciation (NUA) in
employer’s securities

Use this box if a distribution from a qualified plan (except
a qualified distribution from a designated Roth account)
includes securities of the employer corporation (or a
subsidiary or parent corporation) and you can compute
the NUA in the employer’s securities. Enter all the NUA in
employer securities if this is a lump-sum distribution. If
this is not a lump-sum distribution, enter only the NUA in
employer securities attributable to employee
contributions. See Regulations section 1.402(a)-1(b) for
the determination of the NUA. Also see Notice 89-25, Q/
A-1, 1989-1 C.B. 662. Include the NUA in box 1 but not in
box 2a except in the case of a direct rollover to a Roth
IRA (See Notice 2009-75, Q/A 1). You do not have to
complete this box for a direct rollover.

Box 7. Distribution code(s)

Enter an “X” in the IRA/SEP/SIMPLE checkbox if the
distribution is from a traditional IRA, SEP IRA, or SIMPLE
IRA. Do not check the box for a distribution from a Roth
IRA or for an IRA recharacterization.
Enter the appropriate code(s) in box 7. Use the Guide
to Distribution Codes on pages 13 through 15 to
determine the appropriate code(s) to enter in box 7 for
any amounts reported on Form 1099-R. Read the codes
carefully and enter them accurately because the IRS
uses the codes to help determine whether the recipient
has properly reported the distribution. If the codes you
enter are incorrect, the IRS may improperly propose
changes to the recipient’s taxes.
When applicable, enter a numeric and an alpha code.
For example, when using Code P for a traditional IRA
distribution under section 408(d)(4), you must also enter
Code 1, if it applies. For a normal distribution from a
qualified plan that qualifies for the 10-year tax option,
enter Codes 7 and A. For a direct rollover to an IRA or a
qualified plan for the surviving spouse of a deceased
participant, or on behalf of a nonspouse designated
beneficiary, enter Codes 4 and G (Codes 4 and H if from
a designated Roth account to a Roth IRA). If two or more
distribution codes are not valid combinations, you must
file more than one Form 1099-R.
Enter a maximum of two alpha/numeric codes in
box 7. See the Guide to Distribution Codes on
CAUTION pages 13 through 15 for allowable combinations.
Only three numeric combinations are permitted on one
Form 1099-R: Codes 8 and 1, 8 and 2, or 8 and 4. If two
or more other numeric codes are applicable, you must file
more than one Form 1099-R. For example, if part of a
distribution is premature (Code 1) and part is not (Code
7), file one Form 1099-R for the part to which Code 1
applies and another Form 1099-R for the part to which
Code 7 applies. In addition, for the distribution of excess
deferrals, parts of the distribution may be taxable in 2
different years. File separate Forms 1099-R using Code
8 or P to indicate the year the amount is taxable.
Even if the employee/taxpayer is age 591/2 or over, use
Code 1 if a series of substantially equal periodic
payments was modified within 5 years of the date of the
first payment (within the meaning of section 72(q)(3) or
(t)(4)), if you have been reporting distributions in previous
years using Code 2. For example, Mr. B began receiving
payments that qualified for the exception for part of a
series of substantially equal periodic payments under
section 72(t)(2)(A)(iv) when he was 57. When he was 61,
Mr. B substantially modified the payments. Because the
payments were modified within 5 years, use Code 1 in
the year the payments were modified, even though Mr. B
is over 591/2. If you do not know that the taxpayer meets
the requirements for substantially equal periodic
payments under section 72(t)(2)(A)(iv), use Code 1 to
report the payments.

Box 8. Other

Enter the current actuarial value of an annuity contract
that is part of a lump-sum distribution. Do not include this
item in boxes 1 and 2a.
To determine the value of an annuity contract, show
the value as an amount equal to the current actuarial
value of the annuity contract, reduced by an amount
equal to the excess of the employee’s contributions over
the cash and other property (not including the annuity
contract) distributed.
If an annuity contract is part of a multiple recipient
lump-sum distribution, enter in box 8, along with the
current actuarial value, the percentage of the total
annuity contract each Form 1099-R represents.
Also, enter in box 8 the amount of the reduction in the
investment (but not below 0 (zero)) against the cash
value of an annuity contract or the cash surrender value
of a life insurance contract due to charges or payments
for qualified long-term care insurance contracts.

Box 9a. Your percentage of total distribution
If this is a total distribution and it is made to more than
one person, enter the percentage received by the person
whose name appears on Form 1099-R. You need not
complete this box for any IRA distributions or for a direct
rollover.

Box 9b. Total employee contributions

You are not required to enter the total employee
contributions or designated Roth contributions in box 9b.
However, because this information may be helpful to the
recipient, you may choose to report them.
If you choose to report the total employee
contributions or designated Roth contributions, do not
include any amounts recovered tax free in prior years.
For a total distribution, report the total employee
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Instructions for Forms 1099-R and 5498 (2011) 12/

contributions or designated Roth contributions in box 5
rather than in box 9b.

Boxes 12–17. State and local information

These boxes and Copies 1 and 2 are provided for your
convenience only and need not be completed for the IRS.
Use the state and local information boxes to report
distributions and taxes for up to two states or localities.
Keep the information for each state or locality separated
by the broken line. If state or local income tax has been
withheld on this distribution, you may enter it in boxes 12
and 15, as appropriate. In box 13, enter the abbreviated
name of the state and the payer’s state identification
number. The state number is the payer’s identification
number assigned by the individual state. In box 16, enter
the name of the locality. In boxes 14 and 17, you may
enter the amount of the state or local distribution. Copy 1
may be used to provide information to the state or local
tax department. Copy 2 may be used as the recipient’s
copy in filing a state or local income tax return.

Box 10. Amount allocable to IRR within 5
years

Enter the amount of the distribution allocable to an IRR
made within the 5-year period beginning with the first day
of the year in which the rollover was made.
For further guidance on determining amounts allocable
to an IRR, see Notice 2010-84, Q/A-13.

Box 11. 1st year of desig. Roth contrib.

Enter the first year of the 5-taxable-year period. This is
the year in which the designated Roth account was first
established by the recipient.

Guide to Distribution Codes
Distribution Codes

*Used with code ...(if
applicable)

Explanations

1 — Early distribution, no known exception.

Use Code 1 only if the employee/taxpayer has not reached age 591/2, 8, B, L, or P
and you do not know if any of the exceptions under Distribution Code
2, 3, or 4 apply. Use Code 1 even if the distribution is made for
medical expenses, health insurance premiums, qualified higher
education expenses, a first-time home purchase, or a qualified
reservist distribution under section 72(t)(2)(B), (D), (E), (F), or (G).
Code 1 must also be used even if a taxpayer is 591/2 or older and he or
she modifies a series of substantially equal periodic payments under
section 72(q), (t), or (v) prior to the end of the 5-year period which
began with the first payment.

2 — Early distribution, exception applies.

Use Code 2 only if the employee/taxpayer has not reached age 591/2 8, B, or P
and you know the distribution is:
• A Roth IRA conversion (an IRA converted to a Roth IRA).
• A distribution made from a qualified retirement plan or IRA because
of an IRS levy under section 6331.
• A section 457(b) plan distribution that is not subject to the
additional 10% tax. But see Section 457(b) plan distributions on page
12 for information on distributions that may be subject to the 10%
additional tax.
• A distribution from a qualified retirement plan after separation from
service in or after the year the taxpayer has reached age 55.
• A distribution from a governmental defined benefit plan to a public
safety employee after separation from service in or after the year the
employee has reached age 50.
• A distribution that is part of a series of substantially equal periodic
payments as described in section 72(q), (t), (u), or (v).
• A distribution that is a permissible withdrawal under an eligible
automatic contribution arrangement (EACA).
• Any other distribution subject to an exception under section 72(q),
(t), (u), or (v) that is not required to be reported using Code 1, 3, or 4.

3 — Disability.

For these purposes, see section 72(m)(7).

4 — Death.

Use Code 4 regardless of the age of the employee/taxpayer to
8, A, B, G, H, L, or P
indicate payment to a decedent’s beneficiary, including an estate or
trust. Also use it for death benefit payments made by an employer but
not made as part of a pension, profit-sharing, or retirement plan.

5 — Prohibited transaction.

Use Code 5 if there was a prohibited transaction involving the account. None
Code 5 means the account is no longer an IRA.

6 — Section 1035 exchange.

Use Code 6 to indicate the tax-free exchange of life insurance,
annuity, long-term care insurance, or endowment contracts under
section 1035.

7 — Normal distribution.

Use Code 7: (a) for a normal distribution from a plan, including a
A or B
traditional IRA, section 401(k), or section 403(b) plan, if the employee/
taxpayer is at least age 591/2, (b) for a Roth IRA conversion if the
participant is at least age 591/2, and (c) to report a distribution from a
life insurance, annuity, or endowment contract and for reporting
income from a failed life insurance contract under sections 7702(g)
and (h). See Rev. Proc. 2008-42, 2008-29 I.R.B. 160, available at
www.irs.gov/irb/2008-29_IRB/ar19.html. Use Code 7 with Code A or
Code B, if applicable. Generally, use Code 7 if no other code applies.
Do not use Code 7 for a Roth IRA.
Note: Code 1 must be used even if a taxpayer is 591/2 or older and he
or she modifies a series of substantially equal periodic payments
under section 72(q), (t), or (v) prior to the end of the 5-year period.

None

Use Code 7 for a distribution
under IRC 877A((e)(1)(B)

12/

Instructions for Forms 1099-R and 5498 (2011)

-13-

Guide to Distribution Codes
Distribution Codes

*Used with code ...(if
applicable)

Explanations

8 — Excess contributions plus earnings/
Use Code 8 for an IRA distribution under section 408(d)(4), unless
excess deferrals (and/or earnings) taxable in Code P applies. Also use this code for corrective distributions of
2011.
excess deferrals, excess contributions, and excess aggregate
contributions, unless Code P applies. See Corrective Distributions on
page 6 and IRA Revocation or Account Closure on page 3 for more
information.

1, 2, 4, B, or J

9 — Cost of current life insurance protection. Use Code 9 to report premiums paid by a trustee or custodian for
current life or other insurance protection. See box 2a beginning on
page 8 for more information.

None

A — May be eligible for 10-year tax option.

Use Code A only for participants born before January 2, 1936, or their 4 or 7
beneficiaries to indicate the distribution may be eligible for the 10-year
tax option method of computing the tax on lump-sum distributions (on
Form 4972, Tax on Lump-Sum Distributions). To determine whether
the distribution may be eligible for the tax option, you need not
consider whether the recipient used this method (or capital gain
treatment) in the past.

B — Designated Roth account distribution.

Use Code B for a distribution from a designated Roth account. But use 1, 2, 4, 7, 8, G, L, P, or U
Code E for a section 415 distribution under EPCRS (see Code E) or
Code H for a direct rollover to a Roth IRA.

E — Distributions under Employee Plans
Compliance Resolution System (EPCRS).

See Distributions under Employee Plans Compliance Resolutions
System (EPCRS) on page 6.

None

F — Charitable gift annuity.

See Charitable gift annuities on page 10.

None

G — Direct rollover and rollover contribution. Use Code G for a direct rollover from a qualified plan, section 403(b) 4 or B
plan or a governmental section 457(b) plan to an eligible retirement
plan (another qualified plan, a section 403(b) plan, a governmental
section 457(b) plan, or an IRA). See Direct Rollovers on page 3. Also
use Code G for IRA rollover contributions to an accepting employer
plan and for IRRs.
Note: Do not use Code G for a direct rollover from a designated Roth
account to a Roth IRA. Use Code H.
H — Direct rollover of a designated Roth
account distribution to a Roth IRA.

Use Code H for a direct rollover of a distribution from a designated
Roth account to a Roth IRA.

J — Early distribution from a Roth IRA.

Use Code J for a distribution from a Roth IRA when Code Q or Code T 8 or P
does not apply. But use Code 2 for an IRS levy and Code 5 for a
prohibited transaction.

L — Loans treated as deemed distributions
under section 72(p).

Do not use Code L to report a loan offset. See Loans Treated as
Distributions on page 7.

1, 4, or B

12/

N — Recharacterized IRA contribution made
for 2011.

Use Code N for a recharacterization of an IRA contribution made for
2011 and recharacterized in 2011 to another type of IRA by a
trustee-to-trustee transfer or with the same trustee.

None

11/

P — Excess contributions plus earnings/
excess deferrals taxable in 2010.

See the explanation for Code 8. The IRS suggests that anyone using
Code P for the refund of an IRA contribution under section 408(d)(4),
including excess Roth IRA contributions, advise payees, at the time
the distribution is made, that the earnings are taxable in the year in
which the contributions were made.

1, 2, 4, B, or J

Q — Qualified distribution from a Roth IRA.

Use Code Q for a distribution from a Roth IRA if you know that the
participant meets the 5-year holding period and:
• The participant has reached age 591/2,
• The participant died, or
• The participant is disabled.
Note: If any other code, such as 8 or P, applies, use Code J.

None

R — Recharacterized IRA contribution made
for 2010.

Use Code R for a recharacterization of an IRA contribution made for
2010 and recharacterized in 2011 to another type of IRA by a
trustee-to-trustee transfer or with the same trustee.

None

S — Early distribution from a SIMPLE IRA in
the first 2 years, no known exception.

Use Code S only if the distribution is from a SIMPLE IRA in the first 2 None
years, the employee/taxpayer has not reached age 591/2, and none of
the exceptions under section 72(t) are known to apply when the
distribution is made. The 2-year period begins on the day contributions
are first deposited in the individual’s SIMPLE IRA. Do not use Code S
if Code 3 or 4 applies.

T — Roth IRA distribution, exception applies. Use Code T for a distribution from a Roth IRA if you do not know if the None
5-year holding period has been met but:
• The participant has reached age 591/2,
• The participant died, or
• The participant is disabled.
Note: If any other code, such as 8 or P, applies, use Code J.

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Instructions for Forms 1099-R and 5498 (2011)

12/

Guide to Distribution Codes
Distribution Codes
U — Dividends distributed from an ESOP
under section 404(k).

*Used with code ...(if
applicable)

Explanations

Use Code U for a distribution of dividends from an employee stock
B
ownership plan (ESOP) under section 404(k). These are not eligible
rollover distributions. Note: Do not report dividends paid by the
corporation directly to plan participants or their beneficiaries. Continue
to report those dividends on Form 1099-DIV.

W — Charges or payments for purchasing
Use Code W for charges or payments for purchasing qualified
6
qualified long-term care insurance contracts long-term care insurance contracts under combined arrangements
under combined arrangements.
which are excludible under section 72(e)(11) against the cash value of
an annuity contract or the cash surrender value of a life insurance
contract.
*See the first Caution for box 7 instructions on page 12.

participant may choose to recharacterize the contribution
by transferring, in a trustee-to-trustee transfer, any part of
the contribution (plus earnings) to another IRA (second
IRA). The contribution is treated as made to the second
IRA (recharacterization). A recharacterization may be
made with the same trustee or with another trustee. The
trustee of the first IRA must report the amount
contributed before the recharacterization as a
contribution on Form 5498 and the recharacterization as
a distribution on Form 1099-R. The trustee of the second
IRA must report the amount received (FMV) in box 4 on
Form 5498 and check the type of IRA in box 7.
All recharacterized contributions received by an IRA
in the same year must be totaled and reported on one
Form 5498 in box 4. You may report the FMV of the
account on the same Form 5498 you use to report a
recharacterization of an IRA contribution and any other
contributions made to the IRA for the year.
Catch-up contributions. Participants who are age 50
or older by the end of the year may be eligible to make
catch-up IRA contributions or catch-up elective deferral
contributions. The annual IRA regular contribution limit of
$5,000 is increased to $6,000 for participants age 50 or
older. Catch-up elective deferral contributions reported
on Form 5498 may be made under a salary reduction
SEP (SARSEP) or under a SIMPLE IRA plan. For 2011,
up to $5,500 in catch-up elective deferral contributions
may be made under a SARSEP, and up to $2,500 to a
SIMPLE IRA plan. For more information on catch-up
elective deferral contributions, see Regulations section
1.414(v)-1.
Include any catch-up amounts when reporting
contributions for the year in boxes 1, 8, 9, or 10.
Roth IRA conversions. You must report the receipt of a
conversion from an IRA to a Roth IRA even if the
conversion is with the same trustee. Report the total
amount converted from a traditional IRA, SEP IRA, or
SIMPLE IRA to a Roth IRA in box 3.
IRA revocation or account closure. If a traditional
IRA, Roth IRA, or SIMPLE IRA is revoked during its first
7 days (under Regulations section 1.408-6(d)(4)(ii)) or
closed at any time by the IRA trustee pursuant to its
resignation or such other event mandating the closure of
the account, Form 5498 must be filed to report any
regular, rollover, IRA conversion, SEP IRA, or SIMPLE
IRA contributions to the IRA. For information about
reporting a distribution from a revoked or closed IRA, see
IRA Revocation or Account Closure on page 3.
Total distribution, no contributions. Generally, if a
total distribution was made from an account during the
year and no contributions, including rollovers,
recharacterizations, or Roth IRA conversion amounts,
were made for that year, you need not file Form 5498 nor
furnish the annual statement to reflect that the FMV on
December 31 was zero.
Required minimum distributions (RMDs). An IRA
(other than a Roth IRA) owner/participant must begin
taking distributions for each calendar year beginning with

Specific Instructions for Form 5498
13/12

12/

File Form 5498, IRA Contribution Information, with the
IRS by May 31, 2012, for each person for whom in 2011
you maintained any individual retirement arrangement
(IRA), including a deemed IRA under section 408(q).
An IRA includes all investments under one IRA plan. It
is not necessary to file a Form 5498 for each investment
under one plan. For example, if a participant has three
certificates of deposit (CDs) under one IRA plan, only
one Form 5498 is required for all contributions and the
fair market values (FMVs) of the CDs under the plan.
However, if a participant has established more than one
IRA plan with the same trustee, a separate Form 5498
must be filed for each plan.
Contributions. You must report contributions to any
IRA on Form 5498. See the instructions under boxes 1,
2, 3, 4, 8, 9, 10, 13a, and 14a on pages 18 and 19. If no
reportable contributions were made for 2011, complete
only boxes 5 and 7, and boxes 11, 12a, and 12b, if
applicable.
You are required to file Form 5498 even if
required minimum distributions (RMDs) or other
CAUTION annuity or periodic payments have started.
Report contributions to a spousal IRA under section
219(c) on a separate Form 5498 using the name and
taxpayer identification number (TIN) of the spouse.
For contributions made between January 1 and April
17, 2012, trustees and issuers should obtain the
participant’s designation of the year for which the
contributions are made.
Direct rollovers, transfers, and recharacterizations.
You must report the receipt of a direct rollover from a
qualified plan, section 403(b) plan or governmental
section 457(b) plan to an IRA. Report a direct rollover in
box 2. For information on direct rollovers of eligible
rollover distributions, see Direct Rollovers on page 3.
If a rollover or trustee-to-trustee transfer is made from
a savings incentive match plan for employees (SIMPLE)
IRA to an IRA that is not a SIMPLE IRA and the trustee
has adequately substantiated information that the
participant has not satisfied the 2-year period specified in
section 72(t)(6), report the amount as a regular
contribution in box 1 even if the amount exceeds $5,000
($6,000 for participants 50 or older).
Transfers. Do not report on Form 5498 a direct
trustee-to-trustee transfer from (a) a traditional IRA to
another traditional IRA or to a simplified employee
pension (SEP) IRA, (b) a SIMPLE IRA to another
SIMPLE IRA, (c) a SEP IRA to another SEP IRA or to a
traditional IRA, or (d) a Roth IRA to a Roth IRA. For
reporting purposes, contributions and rollovers do not
include these transfers.
Recharacterizations. You must report each
recharacterization of an IRA contribution. If a participant
makes a contribution to an IRA (first IRA) for a year, the

15/13/

12/

Instructions for Forms 1099-R and 5498 (2011)

-15-

13/

the calendar year in which the participant attains age
701/2. The distribution for the 701/2 year must be made no
later than April 1 of the following calendar year; RMDs for
any other year must be made no later than December 31
of the year. See Regulations section 1.401(a)(9)-6 for
RMDs from annuity contracts. Note. A qualified
charitable distribution is counted for purposes of the RMD
requirements under sections 408(a)(6), 408(b)(3), and
408A(c)(5).
For each IRA you held as of December 31 of the prior
year, if an RMD is required for the year, you must provide
a statement to the IRA participant by January 31
regarding the RMD using one of two alternative methods
described below. You are not required to use the same
method for all IRA participants; you can use Alternative
one for some IRA participants and Alternative two for the
rest. Under both methods, the statement must inform the
participant that you are reporting to the IRS that an RMD
is required for the year. The statement can be provided in
conjunction with the statement of the FMV.
If the IRA participant is deceased, and the surviving
spouse is the sole beneficiary, special rules apply for
RMD reporting. If the surviving spouse elects to treat the
IRA as the spouse’s own, then report with the surviving
spouse as the owner. However, if the surviving spouse
does not elect to treat the IRA as the spouse’s own, then
you must continue to treat the surviving spouse as the
beneficiary. Until further guidance is issued, no reporting
is required for IRAs of deceased participants (except
where the surviving spouse elects to treat the IRA as the
spouse’s own, as described above).
Alternative one. Under this method, include in the
statement the amount of the RMD with respect to the IRA
for the calendar year and the date by which the
distribution must be made. The amount may be
calculated assuming the sole beneficiary of the IRA is not
a spouse more than 10 years younger than the
participant. Use the value of the account as of December
31 of the prior year to compute the amount. See boxes
11, 12a, and 12b, on page 18 for how to report.
Alternative two. Under this method, the statement
informs the participant that a minimum distribution with
respect to the IRA is required for the calendar year and
the date by which such amount must be distributed. You
must include an offer to furnish the participant with a
calculation of the amount of the RMD if requested by the
participant.
Electronic filing. These statements may be
furnished electronically using the procedures described in
part F of the 2011 General Instructions for Certain
Information Returns.
Reporting to the IRS. If an RMD is required, check
box 11. See page 18. For example, box 11 is checked on
the Form 5498 for a 2012 RMD. You are not required to
report to the IRS the amount or the date by which the
distribution must be made. However, see the Caution on
page 18 for using boxes 12a and 12b for reporting RMDs
to participants.
For more details, see Notice 2002-27 on page 814 of
Internal Revenue Bulletin 2002-18 at www.irs.gov/pub/
irs-irbs/irb02-18.pdf as clarified by Notice 2003-3 on page
258 of Internal Revenue Bulletin 2003-2 at www.irs.gov/
pub/irs-irbs/irb03-02.pdf and modified by Notice 2009-9,
2009-05 I.R.B. 419, available at www.irs.gov/irb/
2009-05_IRB/ar12.html.
Inherited IRAs. In the year an IRA participant dies, you,
as an IRA trustee or issuer, generally must file a Form
5498 and furnish an annual statement for the decedent
and a Form 5498 and an annual statement for each
nonspouse beneficiary. An IRA holder must be able to
identify the source of each IRA he or she holds for
purposes of figuring the taxation of a distribution from an
IRA. Thus, the decedent’s name must be shown on the

beneficiary’s Form 5498 and annual statement. For
example, you may enter “Brian Willow as beneficiary of
Joan Maple” or something similar that signifies that the
IRA was once owned by Joan Maple. You may
abbreviate the word “beneficiary” as, for example, “bene.”
For a spouse beneficiary, unless the spouse makes
the IRA his or her own, treat the spouse as a nonspouse
beneficiary for reporting purposes. If the spouse makes
the IRA his or her own, do not report the beneficiary
designation on Form 5498 and the annual statement.
An IRA set up to receive a direct rollover for a
nonspouse designated beneficiary is treated as an
inherited IRA.
Fair market value (FMV). On the decedent’s Form
5498 and annual statement, you must enter the FMV of
the IRA on the date of death in box 5. Or you may
choose the alternate reporting method and report the
FMV as of the end of the year in which the decedent
died. This alternate value will usually be zero because
you will be reporting the end-of-year valuation on the
beneficiary’s Form 5498 and annual statement. The
same figure should not be shown on both the
beneficiary’s and decedent’s forms. If you choose to
report using the alternate method, you must inform the
executor or administrator of the decedent’s estate of his
or her right to request a date-of-death valuation.
On the beneficiary’s Form 5498 and annual statement,
the FMV of that beneficiary’s share of the IRA as of the
end of the year must be shown in box 5. Every year
thereafter that the IRA exists, you must file Form 5498
and furnish an annual statement for each beneficiary who
has not received a total distribution of his or her share of
the IRA showing the FMV at the end of the year and
identifying the IRA as described above.
However, if a beneficiary takes a total distribution of
his or her share of the IRA in the year of death, you need
not file a Form 5498 nor furnish an annual statement for
that beneficiary, but you must still file Form 5498 for the
decedent.
If you have no knowledge of the death of an IRA
participant until after you are required to file Form 5498
(May 31), you are not required to file a corrected Form
5498 nor furnish a corrected annual statement. However,
you must still provide the date-of-death valuation in a
timely manner to the executor or administrator upon
request.
In the case of successor beneficiaries, apply the
preceding rules by treating the prior beneficiary as the
decedent and the successor beneficiary as the
beneficiary. Using the example above (Brian Willow as
beneficiary of Joan Maple), when that account passes to
Brian’s successor beneficiary, Maurice Poplar, Form
5498 and the annual statement for Maurice should state
“Maurice Poplar as beneficiary of Brian Willow.” The final
Form 5498 and annual statement for Brian Willow will
state “Brian Willow as beneficiary of Joan Maple” and will
show the FMV as of the date of Brian’s death or year-end
valuation, depending on the method chosen.
For more information about the reporting requirements
for inherited IRAs, see Rev. Proc. 89-52, 1989-2 C.B.
632.
Disaster relief reporting. Special tax law provisions
and reporting instructions may apply when the president
declares a location to be a major disaster area. To
determine the location of and special rules applicable to
individual federally declared disaster areas, go to
IRS.gov and enter the keyword “disaster” in the upper
right hand corner. Then click on “Tax Relief in Disaster
Situations.” The information provided includes:
• A list of the areas for which relief has recently been
granted,
• News Releases detailing the scope of the relief and
any special reporting instructions, and
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Instructions for Forms 1099-R and 5498 (2011) 12/

• A link to the Federal Emergency Management

amount of the gratuity or SGLI payment less any
amounts contributed to Coverdell ESAs. Report the
amount of the rollover contribution in box 2 only. See
section 408A(e)(2), and Notice 2010-15, 2010-06 I.R.B.
390, available at www.irs.gov/irb/2010-06_IRB/ar09.html,
for more information on limitations.
Electronic filers. You may request an automatic
waiver from filing Forms 5498 for combat zone
participants by submitting Form 8508, Request for
Waiver From Filing Information Returns Electronically.
Once you have received the waiver, you may report all
Forms 5498 for combat zone participants on paper.
Alternatively, you may report contributions made by the
normal contribution due date electronically and report the
contributions made after the normal contribution due date
on paper. You may also report prior year contributions by
combat zone participants on a corrected Form 5498
electronically or on paper.
See part F in the 2011 General Instructions for Certain 12/
Information Returns for information on how to request a
waiver on Form 8508.
Corrected Form 5498. If you file a Form 5498 with the
IRS and later discover that there is an error on it, you
must correct it as soon as possible. See part H in the
2011 General Instructions for Certain Information Returns 12/
or Pub. 1220, if filing electronically. For example, if you
reported contributions as rollover contributions in box 2,
and you later discover that part of the contribution was
not eligible to be rolled over and was, therefore, a regular
contribution that should have been reported in box 1
(even if the amount exceeds the regular contribution
limit), you must file a corrected Form 5498.
Statements to participants. If you are required to file
Form 5498, you must provide a statement to the
13/
participant. By January 31, 2012, you must provide
participants with a statement of the December 31, 2011, 12/
value of the participant’s account and RMD, if applicable.
Trustees of SIMPLE IRAs also must provide a statement
of the account activity by January 31. Contribution
information for all other types of IRAs must be provided
13/
by May 31, 2012. You are not required to provide
information to the IRS or to participants as to whether a
contribution is deductible or nondeductible. In addition,
the participant is not required to tell you whether a
contribution is deductible or nondeductible.
If you furnished a statement of the FMV of the
account, and RMD if applicable, to the participant by
13/
January 31, 2012, and no reportable contributions,
including rollovers, recharacterizations, or Roth IRA
conversions, were made for 2011, you need not furnish 12/
another statement (or Form 5498) to the participant to
report zero contributions. However, you must file Form
13/
5498 with the IRS by May 31, 2012, to report the
12/
December 31, 2011, FMV of the account. This rule also
applies to beneficiary accounts under the inherited IRA
rules on page 16.
For more information about the requirement to furnish
statements to participants, see part M in the 2011
12/
General Instructions for Certain Information Returns.

Agency’s list of federal disaster declarations.
See the instructions for boxes 13a through 13c for
reporting postponed contributions on page 19.
Qualified settlement income. Qualified settlement
income received in connection with the Exxon Valdez
litigation may be contributed to a traditional or Roth IRA.
See P.L. 110-343, Division C, sec. 504 for contribution
limitations and Box 2. Rollover contributions on page 18.
Airline payment amount. Qualified airline employees
may contribute the amounts received (money or other
property) with respect to the employee’s interest in a
bankruptcy claim against the airline carrier, to a Roth IRA
as a rollover contribution. See P.L. 110-458, sec. 125 for
contribution limitations and Box 2. Rollover contributions
on page 18.
Special reporting for U.S. Armed Forces in
designated combat zones. A participant who is serving
in or in support of the Armed Forces in a designated
combat zone or qualified hazardous duty area has an
additional period after the normal contribution due date of
April 15 to make IRA contributions for a prior year. The
period is the time the participant was in the designated
zone or area plus at least 180 days. The participant must
designate the IRA contribution for a prior year to claim it
as a deduction on the income tax return.
Under section 219(f), combat zone compensation that
is excluded from gross income under section 112 is
treated as includible compensation for purposes of
determining IRA contributions.
If a qualifying combat zone participant makes a
contribution to an IRA after April 15 and designates the
contribution for a prior year, you must report the type of
IRA (box 7) and the amount on Form 5498. Report the
amount either for (1) the year for which the contribution
was made or (2) a subsequent year.
1. If you report the contribution for the year it is made,
no special reporting is required. Include the contribution
in box 1 or box 10 of an original Form 5498 or of a
corrected Form 5498 if an original was previously filed.
2. If you report the contribution on Form 5498 in a
subsequent year, you must include the year for which the
contribution was made, the amount of the contribution,
and one of the following indicators:
a. Use “AF” (Allied Force) for the Kosovo area.
b. Use “EF” (Enduring Freedom) for Afghanistan,
Uzbekistan, Kyrgyzstan, Pakistan, Tajikistan, Jordan, and
Somalia.
c. Use “IF” (Iraqi Freedom) for the Arabian Peninsula
Areas (the Persian Gulf, the Red Sea, the Gulf of Oman,
the portion of the Arabian Sea that lies north of 10
degrees north latitude and west of 68 degrees east
longitude, the Gulf of Aden, and the total land areas of
Iraq, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, and
the United Arab Emirates and the airspace above such
locations).

09/
09/

12/

See boxes 13a, 13b, and 13c on page 19; also see
Pub. 3, Armed Forces’ Tax Guide, for a list of the
locations within the designated combat zones and
qualified hazardous duty areas.
Example. For a $4,000 IRA contribution designated
for Enduring Freedom for the tax year 2008, enter “4000”
in box 13a, “2008” in box 13b, and “EF” in box 13c only.
Make no entry in box 1 or box 10.
Repayment of qualified reservist distributions.
Report any repayment of a qualified reservist distribution
as described in section 72(t)(2)(G) in boxes 14a (amount)
and 14b (with indicator code “QR”).
Military death gratuities and servicemembers’
group life insurance (SGLI) payments. Recipients of
military death gratuities and SGLI payments may
contribute amounts received to a Roth IRA, up to the
Instructions for Forms 1099-R and 5498 (2011)

If you do not furnish another statement to the
participant because no reportable contributions
CAUTION were made for the year, the statement of the FMV
of the account must contain a legend designating which
information is being filed with the IRS.

Account Number

The account number is required if you have multiple
accounts for a recipient for whom you are filing more than
one Form 5498. Additionally, the IRS encourages you to
designate an account number for all Forms 5498 that you
file. See part L in the 2011 General Instructions for
12/
Certain Information Returns.
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12/
15/13/12/

Box 1. IRA contributions (other than
amounts in boxes 2–4, 8–10, 13a, and 14a)

Box 6. Life insurance cost included in box 1
For endowment contracts only, enter the amount
included in box 1 allocable to the cost of life insurance.

Enter contributions to a traditional IRA made in 2011 and
through April 17, 2012, designated for 2011.
Report gross contributions, including the amount
allocable to the cost of life insurance (see box 6) and
including any excess contributions, even if the excess
contributions were withdrawn. If an excess contribution is
treated as a contribution in a subsequent year under
section 219(f)(6), do not report it on Form 5498 for the
subsequent year. It has already been reported as a
contribution on Form 5498 for the year it was actually
contributed.
Also include employee contributions to an IRA under a
SEP plan. These are contributions made by the
employee, not by the employer, that are treated as
regular IRA contributions subject to the 100% of
compensation and $5,000 ($6,000 for participants 50 or
older) limits of section 219. Do not include employer SEP
IRA contributions or SARSEP contributions under section
408(k)(6). Instead, include them in box 8.
Also, do not include in box 1 contributions to a
SIMPLE IRA (report them in box 9) and a Roth IRA
(report them in box 10). In addition, do not include in box
1 rollovers and recharacterizations (report rollovers in
box 2 and recharacterizations in box 4), or a Roth IRA
conversion amount (report in box 3).

Box 7. Checkboxes

Check the appropriate box.
IRA. Check “IRA” if you are filing Form 5498 to report
information about a traditional IRA account.
SEP. Check “SEP” if you are filing Form 5498 to report
information about a SEP IRA. If you do not know whether
the account is a SEP IRA, check the “IRA” box.
SIMPLE. Check “SIMPLE” if you are filing Form 5498 to
report information about a SIMPLE IRA account. Do not
file Form 5498 for a SIMPLE 401(k) plan. See
section 408(p).
Roth IRA. Check “Roth IRA” if you are filing Form 5498
to report information about a Roth IRA account.

Box 8. SEP contributions

Enter employer contributions made to a SEP IRA
(including salary deferrals under a SARSEP) during 2011 12/
12/11/
including contributions made in 2011 for 2010, but not
including contributions made in 2012 for 2011. Trustees 13/12/
and issuers are not responsible for reporting the year for
which SEP contributions are made. Do not enter
employee contributions to an IRA under a SEP plan.
Report any employee contributions to an IRA under a
SEP plan in box 1. Also include in box 8 SEP
contributions made by a self-employed person to his or
her own account.

Box 2. Rollover contributions

Enter any rollover contributions (or contributions treated
as rollovers) to any IRA received by you during 2011.
These contributions may be any of the following:
• A 60-day rollover between IRAs of the same type.
• A direct or indirect rollover from a qualified plan,
section 403(b) plan or governmental section 457(b) plan.
• Any qualified rollover contribution as defined in section
408A(e) from an eligible retirement plan (other than an
IRA) to a Roth IRA.
• A military death gratuity.
• An SGLI payment.
• Qualified settlement income received in connection
with the Exxon Valdez litigation.
• Airline payment amounts.
For the rollover of property, enter the FMV of the
property on the date you receive it. This value may be
different from the value of the property on the date it was
distributed to the participant.
For more details, see Pub. 590.

Box 9. SIMPLE contributions

Enter contributions, including deferrals, made to a
SIMPLE IRA during 2011. Trustees and issuers are not
responsible for reporting the year for which SIMPLE
contributions are made. Do not include contributions to a
SIMPLE 401(k) plan. A distribution from one SIMPLE IRA
rolled over to another SIMPLE IRA is reported in box 2.

Box 10. Roth IRA contributions

Enter any contributions made to a Roth IRA in 2011 and
through April 17, 2012, designated for 2011. However,
report Roth IRA conversion amounts in box 3. Report a
qualified rollover contribution made under section
408A(e) from an eligible retirement plan (other than an
IRA) to a Roth IRA in box 2.

Box 11. Check if RMD for 2012

Check the box if the participant must take an RMD for
2012. You are required to check the box for the year in
which the IRA participant reaches age 701/2 even though
the RMD for that year need not be made until April 1 of
the following year. Then check the box for each
subsequent year an RMD is required to be made.

Box 3. Roth IRA conversion amount
12/

Enter the amount converted or reconverted from a
traditional IRA, SEP IRA, or SIMPLE IRA to a Roth IRA
during 2011. Do not include a rollover from one Roth IRA
to another Roth IRA, or a qualified rollover contribution
under section 408A(e) from an eligible retirement plan
(other than an IRA) to a Roth IRA. These rollovers are
reported in box 2.

12/

15/13/12/

13/
13/

Boxes 12a and 12b are provided for your use to
report RMD dates and amounts to participants.
CAUTION You may choose to complete these boxes, or
continue to provide a separate Form 5498, or a separate
statement, to report the information required by
Alternative one or Alternative two. See page 16. To
determine the RMD, see the regulations under sections
401(a)(9) and 408(a)(6) and (b)(3).

Box 4. Recharacterized contributions

Enter any amounts recharacterized plus earnings from
one type of IRA to another.

Box 5. Fair market value of account

Box 12a. RMD date

Enter the FMV of the account on December 31. For
inherited IRAs, see Inherited IRAs on page 16.

Enter the RMD date if you are using Form 5498 to report
the additional information. See page 15.

Trustees and custodians are responsible for
ensuring that all IRA assets (including those not
CAUTION traded on established markets or with otherwise
readily determinable market value) are valued annually at
their fair market value.

Box 12b. RMD amount

Enter the RMD amount if you are using Form 5498 to
report the additional information under Alternative one.
See page 16.
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Instructions for Forms 1099-R and 5498 (2011) 12/

Box 13a. Postponed contribution

Report the amount of any postponed contribution made
in 2011 for a prior year. If contributions were made for
more than 1 prior year, each prior year’s postponed
contribution must be reported on a separate form.

EF—Enduring Freedom.
IF —Iraqi Freedom.
• For participants who are “affected taxpayers,” as
described in an IRS News Release relating to a federally
designated disaster area, enter FD.

Box 13b. Year

Box 14a. Repayments

Enter the amount of any repayment of a qualified
reservist distribution or of a designated disaster
distribution (for example, a qualified disaster recovery
assistance distribution).

Enter the year for which the postponed contribution in
box 13a was made.

Box 13c. Code

From the following list of codes, enter the reason the
participant made the postponed contribution.
• For participants’ service in the combat zone or
hazardous duty area, enter:
AF—Allied Force.

Box 14b. Code

Enter QR for the repayment of a qualified reservist
distribution, or DD for repayment of a federally
designated disaster distribution.

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-20-

■

File Type	application/pdf
File Title	Summary of Changes
Author	94vdb
File Modified	2011-11-16
File Created	2011-09-15