Interest Income

9292

VOID

Version A, Cycle 2
Dimensions: 7.3" x 4.5"

CORRECTED

PAYER’S name, street address, city or town, province or state, country, ZIP
or foreign postal code, and telephone no.

Payer's RTN (optional)

OMB No. 1545-0112

2014

1 Interest income

$

Interest Income

Form 1099-INT

2 Early withdrawal penalty
PAYER’S federal identification number RECIPIENT’S identification number

Copy A

$

For
Internal Revenue
Service Center

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

$
4 Federal income tax withheld 5 Investment expenses

RECIPIENT’S name

$

Street address (including apt. no.)

6 Foreign tax paid

File with Form 1096.

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2014 General
Instructions for
Certain
Information
Returns.

$
7 Foreign country or U.S. possession

City or town, province or state, country, and ZIP or foreign postal code

$
8 Tax-exempt interest

$
2nd TIN not. 10 Tax-exempt bond CUSIP no.

Account number (see instructions)

9 Specified private activity bond
interest

$
11 State 12 State identification no. 13 State tax withheld

$
$
Form 1099-INT

Cat. No. 14410K

www.irs.gov/form1099int

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Internal Use Only
DRAFT AS OF
March 28, 2013

VOID

Version A, Cycle 2
Dimensions: 7.3" x 4.5"

CORRECTED

PAYER’S name, street address, city or town, province or state, country, ZIP
or foreign postal code, and telephone no.

Payer's RTN (optional)

OMB No. 1545-0112

2014

1 Interest income

$

Interest Income

Form 1099-INT

2 Early withdrawal penalty
PAYER’S federal identification number RECIPIENT’S identification number

Copy 1

$

For State Tax
Department

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

$
4 Federal income tax withheld 5 Investment expenses

RECIPIENT’S name

Street address (including apt. no.)

$
6 Foreign tax paid

$
7 Foreign country or U.S. possession

City or town, province or state, country, and ZIP or foreign postal code

$
8 Tax-exempt interest

$
Account number (see instructions)

9 Specified private activity bond
interest

$

10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld

$
$
Form 1099-INT

www.irs.gov/form1099int

Department of the Treasury - Internal Revenue Service

Internal Use Only
DRAFT AS OF
March 28, 2013

Version A, Cycle 2
Dimensions: 7.3" x 4.5"

CORRECTED (if checked)
PAYER’S name, street address, city or town, province or state, country, ZIP
or foreign postal code, and telephone no.

Payer's RTN (optional)

OMB No. 1545-0112

2014

1 Interest income

$

Interest Income

Form 1099-INT

2 Early withdrawal penalty
PAYER’S federal identification number RECIPIENT’S identification number

Copy B

$

For Recipient

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

$

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

4 Federal income tax withheld 5 Investment expenses

RECIPIENT’S name

Street address (including apt. no.)

$
6 Foreign tax paid

City or town, province or state, country, and ZIP or foreign postal code

$
8 Tax-exempt interest

$
Account number (see instructions)

$

10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld

$
$
Form 1099-INT

(keep for your records)

www.irs.gov/form1099int

Department of the Treasury - Internal Revenue Service

Internal Use Only
DRAFT AS OF
March 28, 2013

Version A, Cycle 2
Dimensions: 7.3" x 4.5"

Instructions for Recipient
Recipient's identification number. For your protection, this form
may show only the last four digits of your social security number
(SSN), individual taxpayer identification number (ITIN), or adoption
taxpayer identification number (ATIN). However, the issuer has
reported your complete identification number to the IRS and, where
applicable, to state and/or local governments.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
Box 1. Shows taxable interest paid to you during the calendar year by
the payer. This does not include interest shown in box 3. May also
show the total amount of the credits from clean renewable energy
bonds, qualified forestry conservation bonds, new clean renewable
energy bonds, qualified energy conservation bonds, qualified zone
academy bonds, qualified school construction bonds, and build
America bonds that must be included in your interest income. These
amounts were treated as paid to you during 2014 on the credit
allowance dates (March 15, June 15, September 15, and December
15). For more information, see Form 8912, Credit to Holders of Tax
Credit Bonds.
Box 2. Shows interest or principal forfeited because of early
withdrawal of time savings. You may deduct this amount to figure
your adjusted gross income on your income tax return. See the
instructions for Form 1040 to see where to take the deduction.
Box 3. Shows interest on U.S. Savings Bonds, Treasury bills, Treasury
bonds, and Treasury notes. This may or may not all be taxable. See
Pub. 550. This interest is exempt from state and local income taxes.
This interest is not included in box 1.
Box 4. Shows backup withholding. Generally, a payer must backup
withhold if you did not furnish your taxpayer identification number
(TIN) or you did not furnish the correct TIN to the payer. See Form
W-9. Include this amount on your income tax return as tax withheld.
Box 5. Any amount shown is your share of investment expenses of a
single-class REMIC. If you file Form 1040, you may deduct these
expenses on the “Other expenses” line of Schedule A (Form 1040)
subject to the 2% limit. This amount is included in box 1.

Box 6. Shows foreign tax paid. You may be able to claim this tax as a
deduction or a credit on your Form 1040. See your Form 1040
instructions.
Box 7. Shows the country or U.S. possession to which the foreign tax
was paid.
Box 8. Shows tax-exempt interest paid to you during the calendar
year by the payer. Report this amount on line 8b of Form 1040 or
Form 1040A. This amount may be subject to backup withholding. See
box 4.
Box 9. Shows tax-exempt interest subject to the alternative minimum
tax. This amount is included in box 8. See the Instructions for
Form 6251.
Box 10. Shows CUSIP number(s) for tax-exempt bond(s) on which
tax-exempt interest was paid to you during the calendar year and
reported in box 8. If blank, no CUSIP number was issued for the
bond(s).
Boxes 11-13. State tax withheld reporting boxes.
Nominees. If this form includes amounts belonging to another
person(s), you are considered a nominee recipient. Complete a
Form 1099-INT for each of the other owners showing the income
allocable to each. File Copy A of the form with the IRS. Furnish Copy
B to each owner. List yourself as the “payer” and the other owner(s)
as the “recipient.” File Form(s) 1099-INT with Form 1096 with the
Internal Revenue Service Center for your area. On Form 1096 list
yourself as the “filer.” A husband or wife is not required to file a
nominee return to show amounts owned by the other.
Future developments. For the latest information about developments
related to Form 1099-INT and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099int.

Internal Use Only
DRAFT AS OF
March 28, 2013

VOID

Version A, Cycle 2
Dimensions: 7.3" x 4.5"

CORRECTED

PAYER’S name, street address, city or town, province or state, country, ZIP
or foreign postal code, and telephone no.

Payer's RTN (optional)

OMB No. 1545-0112

2014

1 Interest income

$

Interest Income

Form 1099-INT

2 Early withdrawal penalty
PAYER’S federal identification number RECIPIENT’S identification number

Copy 2

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

$
RECIPIENT’S name

Street address (including apt. no.)

4 Federal income tax withheld 5 Investment expenses

$
6 Foreign tax paid

To be filed with
recipients state
income tax
return, when
required.

$
7 Foreign country or U.S. possession

City or town, province or state, country, and ZIP or foreign postal code

$
8 Tax-exempt interest

$
Account number (see instructions)

9 Specified private activity bond
interest

$

10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld

$
$
Form 1099-INT

www.irs.gov/form1099int

Department of the Treasury - Internal Revenue Service

Internal Use Only
DRAFT AS OF
March 28, 2013

VOID

Version A, Cycle 2
Dimensions: 7.3" x 4.5"

CORRECTED

PAYER’S name, street address, city or town, province or state, country, ZIP
or foreign postal code, and telephone no.

Payer's RTN (optional)

OMB No. 1545-0112

2014

1 Interest income

$

Interest Income

Form 1099-INT

2 Early withdrawal penalty
PAYER’S federal identification number RECIPIENT’S identification number

Copy C

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

For Payer

$
4 Federal income tax withheld 5 Investment expenses

RECIPIENT’S name

$

Street address (including apt. no.)

6 Foreign tax paid

$
7 Foreign country or U.S. possession

City or town, province or state, country, and ZIP or foreign postal code

$
8 Tax-exempt interest

$
Account number (see instructions)

9 Specified private activity bond
interest

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2014 General
Instructions for
Certain
Information
Returns.

$

2nd TIN not. 10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld

$
$
Form 1099-INT

www.irs.gov/form1099int

Department of the Treasury - Internal Revenue Service

Internal Use Only
DRAFT AS OF
March 28, 2013

Version A, Cycle 2
Dimensions: 7.3" x 4.5"

Instructions for Payer
General and specific form instructions are provided
separately. To complete Form 1099-INT, use:
• The 2014 General Instructions for Certain Information
Returns, and
• The 2014 Instructions for Forms 1099-INT and 1099-OID.
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, go to
www.irs.gov/form1099int 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 Copy B of this form to the recipient by
February 2, 2015.
File Copy A of this form with the IRS by March 2, 2015. If
you file electronically, the due date is March 31, 2015. 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. The IRS does not provide a fill-in form
option.

Forms 1099-INT and 1098. If you received mortgage interest
in the course of your trade or business, you may have to
report it to the payer of such mortgage interest and to the IRS
on Form 1098, Mortgage Interest Statement. Do not report
mortgage interest to the payer on Form 1099-INT. See the
instructions for Form 1098 for information on reporting
mortgage interest.
Foreign recipient. If the recipient is a nonresident alien, you
may have to withhold federal income tax and file Form 1042-S,
Foreign Person’s U.S. Source Income Subject to Withholding.
See the Instructions for Form 1042-S and Pub. 515,
Withholding of Tax on Nonresident Aliens and Foreign Entities.
Need help? If you have questions about reporting on Form
1099-INT, call the information reporting customer service site
toll free at 1-866-455-7438 or 304-263-8700 (not toll free).
Persons with a hearing or speech disability with access to
TTY/TDD equipment can 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.

Internal Use Only
DRAFT AS OF
March 28, 2013