f1099-k--2022-04-00 (1)

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1010

VOID

CORRECTED

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

FILER’S TIN

OMB No. 1545-2205

PAYEE’S TIN

Form

1a Gross amount of payment
card/third party network
transactions

1099-K

(Rev. April 2022)
For calendar year

Payment Card and
Third Party
Network
Transactions

20

$

DRAFT AS OF
September 8, 2022
DO NOT FILE
1b Card Not Present
transactions

Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator
(EPF)/Other third party

$

Check to indicate transactions
reported are:
Payment card

3 Number of payment
transactions

4 Federal income tax
withheld

$

Third party network

PAYEE’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
PSE’S name and telephone number

5a January

5b February

$

$

5c March

5d April

$

$

5e May

5f June

$

$

5g July

5h August

$

$

5i September

5j October

$

$

5k November

5l December

$

$

2nd TIN not. 6 State

Account number (see instructions)

2 Merchant category code

7 State identification no.

Copy A

For
Internal Revenue
Service Center

File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
current General
Instructions for
Certain Information
Returns.

8 State income tax withheld

$
$
Form 1099-K (Rev. 4-2022)

Cat. No. 54118B

www.irs.gov/Form1099K

Do Not Cut or Separate Forms on This Page

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

VOID

CORRECTED

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

FILER’S TIN

OMB No. 1545-2205

PAYEE’S TIN

Form

1a Gross amount of payment
card/third party network
transactions

1099-K

(Rev. April 2022)
For calendar year

Payment Card and
Third Party
Network
Transactions

20

$

DRAFT AS OF
September 8, 2022
DO NOT FILE
1b Card Not Present
transactions

Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator
(EPF)/Other third party

Check to indicate transactions
reported are:
Payment card

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
PSE’S name and telephone number

Account number (see instructions)

Copy 1

For State Tax
Department

$

3 Number of payment
transactions

4 Federal income tax
withheld

$

Third party network

PAYEE’S name

2 Merchant category code

5a January

5b February

$

$

5c March

5d April

$

$

5e May

5f June

$

$

5g July

5h August

$

$

5i September

5j October

$

$

5k November

5l December

$

$

6 State

7 State identification no.

8 State income tax withheld

$
$
Form 1099-K (Rev. 4-2022)

www.irs.gov/Form1099K

Department of the Treasury - Internal Revenue Service

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

FILER’S TIN

OMB No. 1545-2205

PAYEE’S TIN

Form

1a Gross amount of payment
card/third party network
transactions

1099-K

(Rev. April 2022)
For calendar year

Payment Card and
Third Party
Network
Transactions

20

$

DRAFT AS OF
September 8, 2022
DO NOT FILE
1b Card Not Present
transactions

Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator
(EPF)/Other third party

Check to indicate transactions
reported are:
Payment card

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
PSE’S name and telephone number

Account number (see instructions)

Copy B

For Payee

$

3 Number of payment
transactions

4 Federal income tax
withheld

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

$

Third party network

PAYEE’S name

2 Merchant category code

5a January

5b February

$

$

5c March

5d April

$

$

5e May

5f June

$

$

5g July

5h August

$

$

5i September

5j October

$

$

5k November

5l December

$

$

6 State

7 State identification no.

8 State income tax withheld

$
$
Form 1099-K (Rev. 4-2022)

(Keep for your records)

www.irs.gov/Form1099K

Department of the Treasury - Internal Revenue Service

Instructions for Payee
You have received this form because you have either (a) accepted
payment cards for payments, or (b) received payments through a third
party network in the calendar year reported on this form. Merchant
acquirers and third party settlement organizations, as payment
settlement entities (PSEs), must report the proceeds of payment card
and third party network transactions made to you on Form 1099-K.
The PSE may have contracted with an electronic payment facilitator
(EPF) or other third party payer to make payments to you.

Note: The aggregate gross amount is the total dollar amount of total
reportable payment transactions made to you, without regard to any
adjustments for credits, cash equivalents, discount amounts, fees,
refunded amounts, or any other amounts. The dollar amount of each
transaction is determined on the date of the transaction.
Box 1b. Shows the aggregate gross amount of all reportable payment
transactions made to you through the PSE during the calendar year
where the card was not present at the time of the transaction or the
card number was keyed into the terminal. Typically, this relates to
online sales, phone sales, or catalogue sales. If the box for third party
network is checked, or if these are third party network transactions,
Card Not Present transactions will not be reported.

DRAFT AS OF
September 8, 2022
DO NOT FILE
If you have questions about the amounts reported on this form,
contact the FILER whose information is shown in the upper left corner
on the front of this form. If you do not recognize the FILER shown in
the upper left corner of the form, contact the PSE whose name and
phone number are shown in the lower left corner of the form above
your account number.
Note: For more information on understanding your Form 1099-K, go
to www.irs.gov/KnowYour1099K.

If the Form 1099-K is related to your business, see Pub. 334 for
more information. If the Form 1099-K is related to your work as part of
the gig economy, see www.irs.gov/GigEconomy.
See the separate instructions for your income tax return for using
the information reported on this form.

Payee’s taxpayer identification number (TIN). For your protection,
this form may show only the last four digits of your TIN (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 TIN to the IRS.
Account number. May show an account number or other unique
number the PSE assigned to distinguish your account.
Box 1a. Shows the aggregate gross amount of payment card/third
party network transactions made to you through the PSE during the
calendar year.

Box 2. Shows the merchant category code used for payment card/
third party network transactions (if available) reported on this form.

Box 3. Shows the number of payment transactions (not including
refund transactions) processed through the payment card/third party
network.
Box 4. Shows backup withholding. Generally, a payer must backup
withhold if you did not furnish your TIN or you did not furnish the
correct TIN to the payer. See Form W-9, Request for Taxpayer
Identification Number and Certification, and Pub. 505. Include this
amount on your income tax return as tax withheld.
Boxes 5a–5l. Show the gross amount of payment card/third party
network transactions made to you for each month of the calendar
year.
Boxes 6–8. Show state and local income tax withheld from the
payments.

Future developments. For the latest information about developments
related to Form 1099-K and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/Form1099K.
Free File Program. Go to www.irs.gov/FreeFile to see if you qualify
for no-cost online federal tax preparation, e-filing, and direct deposit
or payment options.

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

FILER’S TIN

OMB No. 1545-2205

PAYEE’S TIN

Form

1a Gross amount of payment
card/third party network
transactions

1099-K

(Rev. April 2022)
For calendar year

Payment Card and
Third Party
Network
Transactions

20

$

DRAFT AS OF
September 8, 2022
DO NOT FILE
1b Card Not Present
transactions

Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator
(EPF)/Other third party

Check to indicate transactions
reported are:
Payment card

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
PSE’S name and telephone number

Account number (see instructions)

Copy 2

$

3 Number of payment
transactions

4 Federal income tax
withheld

$

Third party network

PAYEE’S name

2 Merchant category code

5a January

5b February

$

$

5c March

5d April

$

$

5e May

5f June

$

$

5g July

5h August

$

$

5i September

5j October

$

$

5k November

5l December

$

$

6 State

7 State identification no.

To be filed with the
recipient’s state
income tax return,
when required.

8 State income tax withheld

$
$
Form 1099-K (Rev. 4-2022)

www.irs.gov/Form1099K

Department of the Treasury - Internal Revenue Service