Form 1096 Annual Summary and Transmittal of U.S. Information Retur

Attention filers of Form 1096:
This form is provided for informational purposes only. It appears in red, similar to the official
IRS form. The official printed version of this IRS form is scannable, but a copy, printed from
this website, is not. Do not print and file a Form 1096 downloaded from this website; a
penalty may be imposed for filing with the IRS information return forms that can’t be
scanned. See part O in the current General Instructions for Certain Information Returns,
available at www.irs.gov/form1099, for more information about penalties.
To order official IRS information returns, which include a scannable Form 1096 for filing with
the IRS, visit www.IRS.gov/orderforms. Click on Employer and Information Returns, and
we’ll mail you the forms you request and their instructions, as well as any publications you
may order.
Information returns may also be filed electronically. To file electronically, you must have
software, or a service provider, that will create the file in the proper format. More information
can be found at:
• IRS Filing Information Returns Electronically (FIRE) system (visit www.IRS.gov/FIRE), or
• IRS Affordable Care Act Information Returns (AIR) program (visit www.IRS.gov/AIR).
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.

Do Not Staple

6969

1096

OMB No. 1545-0108

Annual Summary and Transmittal of
U.S. Information Returns

Form
(Rev. February 2021)
Department of the Treasury
Internal Revenue Service

2021

FILER’S name

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

1098-C
78

1099-LTC 1099-MISC 1099-NEC 1099-OID
93
95
71
96

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

1099-CAP 1099-DIV
73
91

3921
25

3922
26

1099-G
86

5498
28

1099-INT
92

1099-K
10

5498-ESA 5498-QA
72
2A

1099-LS
16

5498-SA
27

Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Send this form, with the copies of the form checked in box 6, to the IRS in a flat mailer (not folded).
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. The Taxpayer First Act of
2019, enacted July 1, 2019, authorized the Department of the
Treasury and the IRS to issue regulations that reduce the 250-return
requirement for 2021 tax returns. If those regulations are issued and
effective for 2021 tax returns required to be filed in 2022, we will post
an article at www.irs.gov/Form1099 explaining the change. Until
regulations are issued, however, the number remains at 250, as
reflected in these instructions. For more information, see part F in the
2021 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.

Date ▶

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.
When to file. File Form 1096 as follows.
• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by
February 28, 2022.
• With Forms 1099-NEC, file by January 31, 2022.
• With Forms 5498, file by May 31, 2022.

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

Use the following
address

▲

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 2021 General Instructions for Certain Information Returns.

Internal Revenue Service
Austin Submission Processing Center
P.O. Box 149213
Austin, TX 78714

Cat. No. 14400O

Form 1096 (2021)

Page 2

Form 1096 (2021)

Alaska, Colorado, Hawaii, Idaho,
Illinois, Indiana, Iowa, Kansas,
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 Center
1973 North Rulon White Blvd.
Ogden, UT 84201

If your legal residence or principal place of business is outside the
United States, file with the Internal Revenue Service, Austin Submission
Processing Center, P.O. Box 149213, Austin, TX 78714.
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.
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-NEC
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, 8, 9, 10, 11, and 13
Box 1
Boxes 1, 2, 5, 6, and 8
Boxes 1, 2, 3, and 5
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
2021 General Instructions for Certain Information Returns. Originals
and corrections of the same type of return can be submitted using
one Form 1096.