Return of information as to payments of $600 or more

Caution: DRAFT—NOT FOR FILING
This is an early release draft of an IRS tax form, instructions, or
publication, which the IRS is providing for your information as a courtesy.
Do not file draft forms. Also, do not rely on draft forms, instructions, and
publications for filing. We generally do not release drafts of forms until we
believe we have incorporated all changes. However, unexpected issues
sometimes arise, or legislation is passed, necessitating a change to a draft
form. In addition, forms generally are subject to OMB approval before they
can be officially released. Drafts of instructions and publications usually
have at least some changes before being officially released.
Early release drafts are at IRS.gov/DraftForms, and may remain there
even after the final release is posted at IRS.gov/DownloadForms. All
information about all forms, instructions, and pubs is at IRS.gov/Forms.
Almost every form and publication also has its own page on IRS.gov. For
example, the Form 1040 page is at IRS.gov/Form1040; the Publication 17
page is at IRS.gov/Pub17; the Form W-4 page is at IRS.gov/W4; and the
Schedule A (Form 1040) page is at IRS.gov/ScheduleA. If typing in a link
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respond to all comments due to the high volume we receive. Please note that
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revision of the product.

Do Not Staple

Form

6969

1096

OMB No. 1545-0108

Annual Summary and Transmittal of
U.S. Information Returns

Department of the Treasury
Internal Revenue Service

2019

FILER'S name

DRAFT AS OF
September 10, 2018
DO NOT FILE
Street address (including room or suite number)

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

For Official Use Only

Name of person to contact

Telephone number

Email address

Fax number

1 Employer identification number 2 Social security number

3 Total number of forms

4 Federal income tax withheld 5 Total amount reported with this Form 1096

$

6 Enter an “X” in only one box below to indicate the type of form being filed.
W-2G
32

1097-BTC
50

1098
81

1099-LTC 1099-MISC 1099-OID
93
95
96

$

7 Form 1099-MISC with NEC in box 7, check

1098-C
78

1098-E
84

1098-F
03

1098-Q
74

1098-T
83

1099-A
80

1099-B
79

1099-C
85

1099PATR
97

1099-Q
31

1099-QA
1A

1099-R
98

1099-S
75

1099-SA
94

1099-SB
43

3921
25

1099-CAP 1099-DIV
73
91

3922
26

5498
28

1099-G
86

.

.

1099-INT
92

5498-ESA 5498-QA
72
2A

.

.

.

1099-K
10

▶

1099-LS
16

5498-SA
27

Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct,
and complete.

Future developments. For the latest information about developments
related to Form 1096, such as legislation enacted after it was
published, go to www.irs.gov/Form1096.
Reminder. The only acceptable method of electronically filing
information returns listed on this form in box 6 with the IRS is through
the FIRE System. See Pub. 1220.
Purpose of form. Use this form to transmit paper Forms 1097, 1098,
1099, 3921, 3922, 5498, and W-2G to the IRS.
Caution: If you are required to file 250 or more information returns of
any one type, you must file electronically. If you are required to file
electronically but fail to do so, and you do not have an approved
waiver, you may be subject to a penalty. For more information, see
part F in the 2019 General Instructions for Certain Information Returns.
Forms 1099-QA and 5498-QA can be filed on paper only, regardless
of the number of returns.
Who must file. Any person or entity who files any of the forms shown
in line 6 above must file Form 1096 to transmit those forms to the IRS.
Enter the filer’s name, address (including room, suite, or other unit
number), and taxpayer identification number (TIN) in the spaces
provided on the form. The name, address, and TIN of the filer on this
form must be the same as those you enter in the upper left area of
Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.

Date ▶

When to file. File Form 1096 as follows.
• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by
February 28, 2020.
Caution: We recommend you file Form 1099-MISC, as a stand-alone
shipment, by January 31, 2020, if you are reporting nonemployee
compensation (NEC) in box 7. Also, check box 7 above.
• With Forms 5498, file by June 1, 2020.

Where To File
Send all information returns filed on paper with Form 1096 to the
following.
If your principal business, office
Use the following
or agency, or legal residence in
address
the case of an individual, is
located in
▲

Instructions

Title ▶

▲

Signature ▶

Alabama, Arizona, Arkansas, Delaware,
Florida, Georgia, Kentucky, Maine,
Massachusetts, Mississippi, New
Hampshire, New Jersey, New Mexico,
New York, North Carolina, Ohio, Texas,
Vermont, Virginia

For more information and the Privacy Act and Paperwork Reduction Act Notice,
see the 2019 General Instructions for Certain Information Returns.

Department of the Treasury
Internal Revenue Service Center
Austin, TX 73301

Cat. No. 14400O

Form 1096 (2019)

DRAFT AS OF
September 10, 2018
DO NOT FILE
Page 2

Form 1096 (2019)

Alaska, Colorado, Hawaii, Idaho,
Illinois, Indiana, Iowa, Kansas,
Department of the Treasury
Michigan, Minnesota, Missouri,
Internal Revenue Service Center
Montana, Nebraska, Nevada, North
P.O. Box 219256
Dakota, Oklahoma, Oregon, South
Kansas City, MO 64121-9256
Carolina, South Dakota, Tennessee,
Utah, Washington, Wisconsin, Wyoming
California, Connecticut, District of
Columbia, Louisiana, Maryland,
Pennsylvania, Rhode Island,
West Virginia

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201

If your legal residence or principal place of business is outside the United
States, file with the Department of the Treasury, Internal Revenue Service
Center, Austin, TX 73301.

Transmitting to the IRS. Group the forms by form number and transmit
each group with a separate Form 1096. For example, if you must file both
Forms 1098 and 1099-A, complete one Form 1096 to transmit your Forms
1098 and another Form 1096 to transmit your Forms 1099-A. You need not
submit original and corrected returns separately. Do not send a form (1099,
5498, etc.) containing summary (subtotal) information with Form 1096.
Summary information for the group of forms being sent is entered only in
boxes 3, 4, and 5 of Form 1096. We recommend you file Forms 1099-MISC
reporting NEC separately from 1099-MISC forms not reporting NEC.
Box 1 or 2. Enter your TIN in either box 1 or 2, not both. Individuals not in
a trade or business must enter their social security number (SSN) in box
2. Sole proprietors and all others must enter their employer identification
number (EIN) in box 1. However, sole proprietors who do not have an EIN
must enter their SSN in box 2. Use the same EIN or SSN on Form 1096
that you use on Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.
Box 3. Enter the number of forms you are transmitting with this Form
1096. Do not include blank or voided forms or the Form 1096 in your total.
Enter the number of correctly completed forms, not the number of pages,
being transmitted. For example, if you send one page of three-to-a-page
Forms 1098-E with a Form 1096 and you have correctly completed two
Forms 1098-E on that page, enter “2” in box 3 of Form 1096.
Box 4. Enter the total federal income tax withheld shown on the forms
being transmitted with this Form 1096.
Box 5. No entry is required if you are filing Form 1098-T, 1099-A, or
1099-G. For all other forms in the listing that follows, enter the total of
the amounts from the specific boxes identified for each form.

Form W-2G
Form 1097-BTC
Form 1098
Form 1098-C
Form 1098-E
Form 1098-F
Form 1098-Q
Form 1099-B
Form 1099-C
Form 1099-CAP
Form 1099-DIV
Form 1099-INT
Form 1099-K
Form 1099-LS
Form 1099-LTC
Form 1099-MISC
Form 1099-OID
Form 1099-PATR
Form 1099-Q
Form 1099-QA
Form 1099-R
Form 1099-S
Form 1099-SA
Form 1099-SB
Form 3921
Form 3922
Form 5498
Form 5498-ESA
Form 5498-QA
Form 5498-SA

Box 1
Box 1
Boxes 1 and 6
Box 4c
Box 1
Box 1
Box 4
Boxes 1d and 13
Box 2
Box 2
Boxes 1a, 2a, 3, 9, 10, and 11
Boxes 1, 3, 8, 10, 11, and 13
Box 1a
Box 1
Boxes 1 and 2
Boxes 1, 2, 3, 5, 6, 7, 8, 10, 13, and 14
Boxes 1, 2, 5, 6, and 8
Boxes 1, 2, 3, and 6
Box 1
Box 1
Box 1
Box 2
Box 1
Boxes 1 and 2
Boxes 3 and 4
Boxes 3, 4, and 5
Boxes 1, 2, 3, 4, 5, 8, 9, 10, 12b, 13a,
and 14a
Boxes 1 and 2
Boxes 1 and 2
Box 1

Corrected returns. For information about filing corrections, see the
2019 General Instructions for Certain Information Returns. Originals
and corrections of the same type of return can be submitted using
one Form 1096.