Sch B (1040) Interest and Ordinary Dividends

Version A, Cycle 3

SCHEDULE B
Department of the Treasury
Internal Revenue Service

2022

Go to www.irs.gov/ScheduleB for instructions and the latest information.
Attach to Form 1040 or 1040-SR.

Name(s) shown on return

Part I
Interest

OMB No. 1545-0074

Interest and Ordinary Dividends

(Form 1040)

Attachment
Sequence No. 08
Your social security number

1

Amount

List name of payer. If any interest is from a seller-financed mortgage and the
buyer used the property as a personal residence, see the instructions and list this
interest first. Also, show that buyer’s social security number and address:

(See instructions
and the
Instructions for
Form 1040,
line 2b.)
Note: If you
received a
Form 1099-INT,
Form 1099-OID,
or substitute
statement from
a brokerage firm,
list the firm’s
name as the
payer and enter
the total interest
shown on that
form.

1

INTERNAL USE ONLY
DRAFT AS OF
July 1, 2022
2
3

Part II
Ordinary
Dividends

Add the amounts on line 1 . . . . . . . . . . . . . . . . . . .
Excludable interest on series EE and I U.S. savings bonds issued after 1989.
Attach Form 8815
. . . . . . . . . . . . . . . . . . . . .
4
Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b
Note: If line 4 is over $1,500, you must complete Part III.
List name of payer:
5

(See instructions
and the
Instructions for
Form 1040,
line 3b.)

Caution: If
required, failure to
file FinCEN Form
114 may result in
substantial
penalties.
Additionally, you
may be required
to file Form 8938,
Statement of
Specified Foreign
Financial Assets.
See instructions.

3
4

Amount

5

Note: If you
received a
Form 1099-DIV
or substitute
statement from
a brokerage firm,
list the firm’s
name as the
payer and enter
the ordinary
6
Add the amounts on line 5. Enter the total here and on Form 1040 or 1040-SR, line 3b
dividends shown
on that form.
Note: If line 6 is over $1,500, you must complete Part III.

Part III
Foreign
Accounts
and Trusts

2

6

You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign
account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.
Yes No
7a

At any time during 2022, did you have a financial interest in or signature authority over a financial
account (such as a bank account, securities account, or brokerage account) located in a foreign
country? See instructions . . . . . . . . . . . . . . . . . . . . . . . .
If “Yes,” are you required to file FinCEN Form 114, Report of Foreign Bank and Financial
Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114
and its instructions for filing requirements and exceptions to those requirements . . . . . .

b If you are required to file FinCEN Form 114, list the name(s) of the foreign country(-ies) where the
financial account(s) are located:
8

During 2022, did you receive a distribution from, or were you the grantor of, or transferor to, a
foreign trust? If “Yes,” you may have to file Form 3520. See instructions . . . . . . . . .

For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 17146N

Schedule B (Form 1040) 2022