1099-G Certain Government Payments

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the official IRS
form. Do not file copy A downloaded from this website. The official printed version of this IRS form is
scannable, but the online version of it, printed from this website, is not. A penalty may be imposed for
filing forms that can’t be scanned. See part O in the current General Instructions for Certain
Information Returns for more information about penalties.
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See IRS Publications 1141, 1167, 1179 and other IRS resources for information about printing these
tax forms.

VOID

8686

CORRECTED

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

1 Unemployment compensation OMB No. 1545-0120

2 State or local income tax
refunds, credits, or offsets

$
PAYER’S federal identification number RECIPIENT’S identification number

Form

3 Box 2 amount is for tax year

Certain
Government
Payments

2015

$

1099-G

4 Federal income tax withheld

$
5 RTAA payments

RECIPIENT’S name

$
Street address (including apt. no.)

$
$
10a State

10b State identification no.

Account number (see instructions)
Form 1099-G

Cat. No. 14438M

www.irs.gov/form1099g

File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the 2015
General
11 State income tax withheld
Instructions for
$
Certain Information
$
Returns.

8 Check if box 2 is
trade or business
income

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

For
Internal Revenue
Service Center

6 Taxable grants

$

7 Agriculture payments

Copy A

▶

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

VOID

CORRECTED

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

1 Unemployment compensation OMB No. 1545-0120

2 State or local income tax
refunds, credits, or offsets

$
PAYER’S federal identification number RECIPIENT’S identification number

Form

3 Box 2 amount is for tax year

Certain
Government
Payments

2015

$

1099-G

4 Federal income tax withheld

$
5 RTAA payments

RECIPIENT’S name

$
$

Street address (including apt. no.)

For State Tax
Department

6 Taxable grants

$

7 Agriculture payments

8 Check if box 2 is
trade or business
income

Copy 1

▶

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

$
10a State

Form 1099-G

10b State identification no.

11 State income tax withheld

$
$

Account number (see instructions)

www.irs.gov/form1099g

Department of the Treasury - Internal Revenue Service

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

1 Unemployment compensation OMB No. 1545-0120

2015

$
2 State or local income tax
refunds, credits, or offsets

$
PAYER’S federal identification number RECIPIENT’S identification number

Form

3 Box 2 amount is for tax year

1099-G

4 Federal income tax withheld

$
5 RTAA payments

RECIPIENT’S name

$
Street address (including apt. no.)

$

6 Taxable grants
8 If checked, box 2 is
trade or business
▶
income

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

$
10a State

10b State identification no.

Form 1099-G

(keep for your records)

11 State income tax withheld

$
$

Account number (see instructions)

www.irs.gov/form1099g

Copy B
For Recipient

$

7 Agriculture payments

Certain
Government
Payments

This is important tax
information and is
being furnished to the
Internal Revenue
Service. If you are
required to file a return,
a negligence penalty or
other sanction may be
imposed on you if this
income is taxable and
the IRS determines that
it has not been
reported.

Department of the Treasury - Internal Revenue Service

Instructions for Recipient

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), adoption taxpayer identification number (ATIN), or
employer identification number (EIN). However, the issuer has reported your
complete identification number to the IRS.
Account number. May show an account or other unique number the payer has
assigned to distinguish your account.
Box 1. Shows the total unemployment compensation paid to you this year.
Combine the box 1 amounts from all Forms 1099-G and report the total as
income on the unemployment compensation line of your tax return. Except as
explained below, this is your taxable amount. If you are married filing jointly,
each spouse must figure his or her taxable amount separately. If you expect to
receive these benefits in the future, you can ask the payer to withhold federal
income tax from each payment. Or, you can make estimated tax payments. For
details, see Form 1040-ES. If you made contributions to a governmental
unemployment compensation program or to a governmental paid family leave
program and received a payment from that program, the payer must issue a
separate Form 1099-G to report this amount to you. If you itemize deductions,
you may deduct your contributions on Schedule A (Form 1040) as taxes paid. If
you do not itemize, you only need to include in income the amount that is in
excess of your contributions.
Box 2. Shows refunds, credits, or offsets of state or local income tax you
received. It may be taxable to you if you deducted the state or local income tax
paid on Schedule A (Form 1040). Even if you did not receive the amount shown,
for example, because: (a) it was credited to your state or local estimated tax, (b)
it was offset against federal or state debts, (c) it was offset against other offsets,
or (d) you made a charitable contribution from your refund, it is still taxable if it
was deducted. If you received interest on this amount, you should receive Form
1099-INT for the interest. However, the payer may include interest of less than
$600 in the blank box next to box 9 on Form 1099-G. Regardless of whether the

interest is reported to you, report it as interest income on your tax return. See
your tax return instructions.
Box 3. Identifies the tax year for which the box 2 refunds, credits, or offsets
shown were made. If there is no entry in this box, the refund is for 2014 taxes.
Box 4. Shows backup withholding or withholding you requested on
unemployment compensation, Commodity Credit Corporation (CCC) loans, or
certain crop disaster payments. Generally, a payer must backup withhold on
certain payments if you did not give your taxpayer identification number to the
payer. See Form W-9 for information on backup withholding. Include this
amount on your income tax return as tax withheld.
Box 5. Shows reemployment trade adjustment assistance (RTAA) payments you
received. Include on Form 1040 on the “Other income” line. See the Form 1040
instructions.
Box 6. Shows taxable grants you received from a federal, state, or local
government.
Box 7. Shows your taxable Department of Agriculture payments. If the payer
shown is anyone other than the Department of Agriculture, it means the payer
has received a payment, as a nominee, that is taxable to you. This may
represent the entire agricultural subsidy payment received on your behalf by the
nominee, or it may be your pro rata share of the original payment. See Pub. 225
and the Instructions for Schedule F (Form 1040) for information about where to
report this income. Partnerships, see Form 8825 for how to report.
Box 8. If this box is checked, the amount in box 2 is attributable to an income
tax that applies exclusively to income from a trade or business and is not a tax
of general application. If taxable, report the amount in box 2 on Schedule C or F
(Form 1040), as appropriate.
Box 9. Shows market gain on CCC loans whether repaid using cash or CCC
certificates. See the Instructions for Schedule F (Form 1040).
Boxes 10a–11. State income tax withheld reporting boxes.
Future developments. For the latest information about developments related to
Form 1099-G and its instructions, such as legislation enacted after they were
published, go to www.irs.gov/form1099g.

VOID

CORRECTED

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

1 Unemployment compensation OMB No. 1545-0120

2 State or local income tax
refunds, credits, or offsets

$
PAYER’S federal identification number RECIPIENT’S identification number

Form

3 Box 2 amount is for tax year

Certain
Government
Payments

2015

$

1099-G

4 Federal income tax withheld

$
5 RTAA payments

RECIPIENT’S name

$

$

7 Agriculture payments

$

Street address (including apt. no.)

6 Taxable grants
8 Check if box 2 is
trade or business
income

▶

Copy 2
To be filed with
recipient's state
income tax
return, when
required.

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

$
10a State

Form 1099-G

10b State identification no.

11 State income tax withheld

$
$

Account number (see instructions)

www.irs.gov/form1099g

Department of the Treasury - Internal Revenue Service

VOID

CORRECTED

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

1 Unemployment compensation OMB No. 1545-0120

2 State or local income tax
refunds, credits, or offsets

$
PAYER’S federal identification number RECIPIENT’S identification number

Form

3 Box 2 amount is for tax year

Certain
Government
Payments

2015

$

1099-G

4 Federal income tax withheld

$
5 RTAA payments

RECIPIENT’S name

$

For Payer

6 Taxable grants

$

7 Agriculture payments

$

Street address (including apt. no.)

8 Check if box 2 is
trade or business
income

▶

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

$
10a State

Form 1099-G

10b State identification no.

11 State income tax withheld

$
$

Account number (see instructions)

www.irs.gov/form1099g

Copy C

For Privacy Act
and Paperwork
Reduction Act
Notice, see the 2015
General
Instructions for
Certain Information
Returns.

Department of the Treasury - Internal Revenue Service

Instructions for Payer
To complete Form 1099-G, use:
• the 2015 General Instructions for Certain Information
Returns, and
• the 2015 Instructions for Form 1099-G.
To order these instructions and additional forms, go
to www.irs.gov/form1099g or call 1-800-TAX-FORM
(1-800-829-3676).
Caution. Because paper forms are scanned during
processing, you cannot file 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 1, 2016.

File Copy A of this form with the IRS by February 29,
2016. If you file electronically, the due date is March 31,
2016. To file electronically, you must have software that
generates a file according to the specifications in Pub.
1220, Specifications for Electronic Filing of Forms 1097,
1098, 1099, 3921, 3922, 5498, and W-2G. The IRS does
not provide a fill-in form option.
Need help? If you have questions about reporting on
Form 1099-G, 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).