2027 Form 1099-R

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TREASURY/IRS AND OMB USE ONLY DRAFT

9898

VOID

CORRECTED
1

PAYER’S name

Gross distribution

OMB No. 1545-0119

2a Taxable amount

2027

$

Form 1099-R

$
Street address

Room/suite no.

City/town

Telephone number

State/province

Country

PAYER’S TIN

RECIPIENT’S TIN

2b Taxable amount not
determined

ZIP/foreign code

3

Total
distribution

Capital gain (included in
box 2a)

4

Employee contrib./
desig. Roth contrib. or
insurance premiums

6

$
5

RECIPIENT’S name

For
Internal Revenue
Service Center

Federal income tax
withheld

7b IRA/SEP/
SIMPLE

NUA in employer’s
securities

For filing information,
Privacy Act, and
$
Paperwork Reduction
7c Trump
7d Earnings on
Act Notice, see the
excess
account

General
Instructions
for Certain
Information
Returns.

contrib.

$
8a Other

City/town

8b Percentage of annuity
contract

$
State/province

Country

9a Percentage of total dist.

ZIP/foreign code

% $
10 Amount allocable to IRR within 11 1st year of desig. 12 FATCA filing
5 years
Roth contrib.
requirement

$
13 Date of
payment

Account number (see instructions)

Form 1099-R Created 9/22/26

Cat. No. 14436Q

14 State tax withheld

www.irs.gov/Form1099

15 State/Payer’s state no.

$
$

16 State distribution

$
$

17 Local tax withheld

$
$

18 Name of locality

19 Local distribution

$
$

www.irs.gov/Form1099R

Do Not Cut or Separate Forms on This Page

%

9b Total employee contrib.

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

7a Dist.
code(s)

Apt. no.

Copy A

$

$
Street address

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.

TREASURY/IRS AND OMB USE ONLY DRAFT
VOID

CORRECTED
1

PAYER’S name

Gross distribution

OMB No. 1545-0119

2a Taxable amount

2027

$

Form 1099-R

$
Street address

Room/suite no.

City/town

Telephone number

State/province

Country

ZIP/foreign code

PAYER’S TIN

RECIPIENT’S TIN

2b Taxable amount not
determined
3

Total
distribution

Capital gain (included in
box 2a)

4

Employee contrib./
desig. Roth contrib. or
insurance premiums

6

$
5

RECIPIENT’S name

For
State, City,
or Local
Tax Department

Federal income tax
withheld

7a Dist.
code(s)

NUA in employer’s
securities

$
7b IRA/SEP/
SIMPLE

7c Trump
7d Earnings on
excess
account
contrib.

$
8a Other

City/town

$
State/province

Country

ZIP/foreign code

9a Percentage of total dist.

8b Percentage of annuity
contract

%

9b Total employee contrib.

% $
10 Amount allocable to IRR within 11 1st year of desig. 12 FATCA filing
5 years
Roth contrib.
requirement

$
Account number (see instructions)

Form 1099-R

13 Date of
payment

www.irs.gov/Form1099R

14 State tax withheld

15 State/Payer’s state no.

$
$
17 Local tax withheld

$
$

16 State distribution

$
$
18 Name of locality

19 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Apt. no.

Copy 1

$

$
Street address

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.

TREASURY/IRS AND OMB USE ONLY DRAFT
CORRECTED (if checked)
1

PAYER’S name

Gross distribution

OMB No. 1545-0119

2a Taxable amount

2027

$

Form 1099-R

$
Street address

Room/suite no.

City/town

Telephone number

State/province

Country

ZIP/foreign code

PAYER’S TIN

RECIPIENT’S TIN

2b Taxable amount not
determined
3

Total
distribution

Capital gain (included in
box 2a)

4

Employee contrib./
desig. Roth contrib. or
insurance premiums

6

$
5

RECIPIENT’S name

Report this
income on your
federal tax
return. If this
form shows
federal income
tax withheld in
box 4, attach
this copy to
your return.

Federal income tax
withheld

7a Dist.
code(s)

NUA in employer’s
securities

$
7b IRA/SEP/
SIMPLE

7c Trump
7d Earnings on
excess
account
contrib.

$
8a Other

City/town

$
State/province

Country

ZIP/foreign code

9a Percentage of total dist.

8b Percentage of annuity
contract

This information is
being furnished to
the IRS.

%

9b Total employee contrib.

% $
10 Amount allocable to IRR within 11 1st year of desig. 12 FATCA filing
5 years
Roth contrib.
requirement

$
Account number (see instructions)

Form 1099-R

13 Date of
payment

www.irs.gov/Form1099R

14 State tax withheld

15 State/Payer’s state no.

$
$
17 Local tax withheld

$
$

16 State distribution

$
$
18 Name of locality

19 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Apt. no.

Copy B

$

$
Street address

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.

TREASURY/IRS AND OMB USE ONLY DRAFT
Generally, distributions from retirement plans (IRAs, qualified plans,
section 403(b) plans, and governmental section 457(b) plans),
insurance contracts, etc., are reported to recipients on Form 1099-R.
Qualified plans and section 403(b) plans. If your annuity starting
date is after 1997, you must use the simplified method to figure your
taxable amount if your payer didn’t show the taxable amount in box
2a. See the instructions for your tax return.
Traditional IRAs or traditional SIMPLE IRAs. For distributions from
a traditional individual retirement arrangement (IRA) or a traditional
SIMPLE IRA, generally the payer isn’t required to compute the taxable
amount. See the instructions for your tax return to determine the
taxable amount. If you’re at least age 73, you must take minimum
distributions from your IRA (other than a Roth IRA or Roth SIMPLE
IRA). If you don’t, you’re subject to an excise tax on the amount that
should’ve been distributed. See Pub. 590-A and Pub. 590-B for more
information on IRAs.
Roth IRAs or Roth SIMPLE IRAs. For distributions from a Roth IRA
or Roth SIMPLE IRA, generally the payer isn’t required to compute the
taxable amount. You must compute any taxable amount on Form
8606. An amount shown in box 2a may be taxable earnings on an
excess contribution.
Loans treated as distributions. If you borrow money from a qualified
plan, section 403(b) plan, or governmental section 457(b) plan, you
may have to treat the loan as a distribution and include all or part of
the amount borrowed in your income. There are exceptions to this rule.
If your loan is taxable, code L will be shown in box 7a. See Pub. 575.
Recipient’s taxpayer identification number (TIN). For your
protection, this form may show only the last 4 digits of your TIN (SSN,
ITIN, ATIN, or EIN). However, the payer has reported your complete
TIN to the IRS.
Account number. May show an account, policy, or other unique
number the payer assigned to distinguish your account.
Box 1. Shows the total amount distributed this year. The amount may
have been a direct rollover, a transfer or conversion to a Roth IRA or
Roth SIMPLE IRA, a recharacterized IRA contribution, or you may
have received it as periodic payments, nonperiodic payments, or a
total distribution. Report the amount on Form 1040, 1040-SR, or
1040-NR on the line for “IRA distributions” or “Pensions and

annuities” (or the line for “Taxable amount”) and on Form 8606, as
applicable. However, if this is a lump-sum distribution, see Form 4972.
If you haven’t reached minimum retirement age, report your disability
payments on the line for “Wages, salaries, tips, etc.” on your tax
return. Also report on that line permissible withdrawals from eligible
automatic contribution arrangements and corrective distributions of
excess deferrals, excess contributions, or excess aggregate
contributions except if the distribution is of designated Roth
contributions or your after-tax contributions or if you’re self-employed.
If a life insurance, annuity, qualified long-term care, or endowment
contract was transferred tax free to another trustee or contract issuer,
an amount will be shown in this box and code 6 will be shown in box
7a. Additionally, code C will be shown in box 7a if the transfer was of
a section 6050Y interest in a life insurance contract. If a charge or
payment was made against the cash value of an annuity contract or
the cash surrender value of a life insurance contract for the purchase
of qualified long-term care insurance, an amount will be shown in this
box and code W will be shown in box 7a. You need not report these
amounts on your tax return. If code 4 and code C are shown in box
7a, the amount shown in box 1 is a receipt of reportable death
benefits that is taxable in part.
Box 2a. This part of the distribution is generally taxable. If there is no
entry in this box, the payer may not have all the facts needed to figure
the taxable amount. In that case, the first box in box 2b should be
checked. You may want to get one of the free publications from the
IRS to help you figure the taxable amount. See Additional information
on the back of Copy 2. For an IRA distribution, see Traditional IRAs or
Traditional SIMPLE IRAs and Roth IRAs or Roth SIMPLE IRAs, earlier.
For a direct rollover, other than from a qualified plan, section 403(b)
plan, or governmental section 457(b) plan to a designated Roth
account in the same plan or to a Roth IRA, zero should be shown and
you must enter -0- on the “Taxable amount” line of your tax return. If
you roll over a distribution (other than a distribution from a designated
Roth account) from a qualified plan, section 403(b) plan, or
governmental section 457(b) plan to a designated Roth account in the
same plan or to a Roth IRA, you must include on the “Taxable
amount” line of your tax return the amount shown in this box plus the
amount in box 6, if any.
(continued on the back of Copy C)

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Instructions for Recipient

TREASURY/IRS AND OMB USE ONLY DRAFT
CORRECTED (if checked)
1

PAYER’S name

Gross distribution

OMB No. 1545-0119

2a Taxable amount

2027

$

Form 1099-R

$
Street address

Room/suite no.

City/town

Telephone number

State/province

Country

ZIP/foreign code

PAYER’S TIN

RECIPIENT’S TIN

2b Taxable amount not
determined
3

Total
distribution

Capital gain (included in
box 2a)

4

Employee contrib./
desig. Roth contrib. or
insurance premiums

6

$
5

RECIPIENT’S name

7a Dist.
code(s)

$
State/province

Country

9a Percentage of total dist.

ZIP/foreign code

NUA in employer’s
securities

$
7b IRA/SEP/
SIMPLE

8a Other

City/town

For Recipient’s
Records

Federal income tax
withheld

7c Trump
7d Earnings on
excess
account
contrib.

This information is
being furnished
$
to the IRS.
8b Percentage of annuity
Explore options to
contract
file for free at
%
www.irs.gov/FFForm.
9b Total employee contrib.

% $
10 Amount allocable to IRR within 11 1st year of desig. 12 FATCA filing
5 years
Roth contrib.
requirement

$
Account number (see instructions)

Form 1099-R

(keep for your records)

13 Date of
payment

14 State tax withheld

15 State/Payer’s state no.

$
$
17 Local tax withheld

$
$

www.irs.gov/Form1099R

16 State distribution

$
$
18 Name of locality

19 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Apt. no.

Copy C

$

$
Street address

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.

TREASURY/IRS AND OMB USE ONLY DRAFT
If this is a total distribution from a qualified plan and you were born
before January 2, 1936 (or you’re the beneficiary of someone born
before January 2, 1936), you may be eligible for the 10-year tax
option. See the Form 4972 instructions for more information.
If you’re an eligible retired public safety officer who elected to
exclude from income distributions from your eligible plan used to pay
certain insurance premiums, the amount shown in box 2a hasn’t been
reduced by the exclusion amount. See the instructions for your tax
return for more information.
Box 2b. If the first box is checked, the payer was unable to determine
the taxable amount and box 2a should be blank, except for a
traditional IRA or traditional SIMPLE IRA. It’s your responsibility to
determine the taxable amount. If the second box is checked, the
distribution was a total distribution that closed out your account.
Box 3. If you received a lump-sum distribution from a qualified plan
and were born before January 2, 1936 (or you’re the beneficiary of
someone born before January 2, 1936), you may be able to elect to
treat this amount as a capital gain on Form 4972 (not on Schedule D
(Form 1040)). See the Form 4972 instructions. For a charitable gift
annuity, report as a long-term capital gain as explained in the
Instructions for Form 8949.
Box 4. Shows federal income tax withheld. Include this amount on
your income tax return as tax withheld. Generally, if you receive
payments that aren’t eligible rollover distributions, you can change
your withholding or elect not to have income tax withheld by giving
the payer Form W-4P or Form W-4R, as applicable.
Box 5. Generally, this shows the employee’s investment in the
contract (after-tax contributions), if any, recovered tax free this year;
the portion that’s your basis in a designated Roth account; the part of
premiums paid on commercial annuities or insurance contracts
recovered tax free; the nontaxable part of a charitable gift annuity; or
the investment in a life insurance contract reportable under section
6050Y. This box doesn’t show any IRA contributions. If the amount
shown is your basis in a designated Roth account, the year you first
made contributions to that account may be entered in box 11.
Box 6. If you received a lump-sum distribution from a qualified plan
that includes securities of the employer’s company, the net unrealized

appreciation (NUA) (any increase in value of such securities while in
the trust) is taxed only when you sell the securities unless you choose
to include it in your gross income this year. See Pub. 575 and
Form 4972. If you roll over the distribution to a designated Roth
account in the same plan or to a Roth IRA or Roth SIMPLE IRA, see
the instructions for box 2a. For a direct rollover to a designated Roth
account in the same plan or to a Roth IRA or Roth SIMPLE IRA, the
NUA is included in box 2a. If you didn’t receive a lump-sum
distribution, the amount shown is the NUA attributable to employee
contributions, which isn’t taxed until you sell the securities.
Box 7a. The following codes identify the distribution you received. For
more information on these distributions, see the instructions for your
tax return. Also, certain distributions may be subject to an additional
10% tax. See the Instructions for Form 5329.
1—Early distribution, no known exception (in most cases, under age
59½).
2—Early distribution, exception applies (under age 59½).
3—Disability.
4—Death.
5—Prohibited transaction.
6—Section 1035 exchange (a tax-free exchange of life insurance,
annuity, qualified long-term care insurance, or endowment contracts).
7—Normal distribution.
8—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2027.
9—Cost of current life insurance protection.
A—May be eligible for 10-year tax option (see Form 4972).
B—Designated Roth account distribution.
Note: If code B is in box 7a and an amount is reported in box 10, see
the Instructions for Form 5329.
C—Reportable death benefits from, or exchange of, a section 6050Y
interest.
D—Annuity payments from nonqualified annuities that may be subject
to tax under section 1411.
E—Distributions under Employee Plans Compliance Resolution
System (EPCRS).
F—Charitable gift annuity.
(continued on the back of Copy 2)

DRAFT — DO NOT FILE

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Instructions for Recipient (continued)

TREASURY/IRS AND OMB USE ONLY DRAFT
CORRECTED (if checked)
1

PAYER’S name

Gross distribution

OMB No. 1545-0119

2a Taxable amount

2027

$

Form 1099-R

$
Street address

Room/suite no.

City/town

Telephone number

State/province

Country

ZIP/foreign code

PAYER’S TIN

RECIPIENT’S TIN

2b Taxable amount not
determined
3

Total
distribution

Capital gain (included in
box 2a)

4

Employee contrib./
desig. Roth contrib. or
insurance premiums

6

$
5

RECIPIENT’S name

File this copy
with your state,
city, or local
income tax
return, when
required.

Federal income tax
withheld

7a Dist.
code(s)

NUA in employer’s
securities

$
7b IRA/SEP/
SIMPLE

7c Trump
7d Earnings on
excess
account
contrib.

$
8a Other

City/town

$
State/province

Country

ZIP/foreign code

9a Percentage of total dist.

8b Percentage of annuity
contract

%

9b Total employee contrib.

% $
10 Amount allocable to IRR within 11 1st year of desig. 12 FATCA filing
5 years
Roth contrib.
requirement

$
Account number (see instructions)

Form 1099-R

13 Date of
payment

www.irs.gov/Form1099R

14 State tax withheld

15 State/Payer’s state no.

$
$
17 Local tax withheld

$
$

16 State distribution

$
$
18 Name of locality

19 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Apt. no.

Copy 2

$

$
Street address

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.

TREASURY/IRS AND OMB USE ONLY DRAFT
G—Direct rollover of a distribution to a qualified plan, a section 403(b)
plan, a governmental section 457(b) plan, or an IRA. Also, a direct
rollover of the entire balance of a Trump account to an ABLE
account of the account beneficiary in the year the beneficiary
reaches age 17.
H—Direct rollover of a designated Roth account distribution to a Roth
IRA or Roth SIMPLE IRA.
J—Early distribution from a Roth IRA or Roth SIMPLE IRA, no known
exception (in most cases, under age 59½).
K—Distribution of traditional IRA assets not having a readily available
FMV.
L—Loans treated as distributions.
M—Qualified plan loan offset.
N—Recharacterized IRA contribution made for 2027 and
recharacterized in 2027.
P—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2026 or a previous year.
Q—Qualified distribution from a Roth IRA or Roth SIMPLE IRA.
R—Recharacterized IRA contribution made for 2026 or a previous
year and recharacterized in 2027.
S—Early distribution from a SIMPLE IRA in first 2 years, no known
exception (under age 59½).
T—Roth IRA or Roth SIMPLE IRA distribution, exception applies.
U—Dividend distribution from ESOP under section 404(k).
Note: This distribution isn’t eligible for rollover.
W—Charges or payments for purchasing qualified long-term care
insurance contracts under combined arrangements.
Y—Qualified charitable distribution (QCD) claimed by taxpayer under
section 408(d)(8).
Box 7b. If the IRA/SEP/SIMPLE box is checked, you’ve received a
traditional IRA (other than a Trump account), SEP, or SIMPLE
distribution.
Box 7c. If the Trump account box is checked, you’ve received a
distribution from a Trump account.
Box 7d. Shows the earnings attributable to the distributed excess
contributions made to a Trump account. These earnings are subject to
a 100% tax.

Boxes 8a and 8b. If you received an annuity contract as part of a
distribution, the value of the contract is shown. It isn’t taxable when
you receive it and shouldn’t be included in boxes 1 and 2a. When you
receive periodic payments from the annuity contract, they’re taxable
at that time. Your percentage is shown if the distribution is made to
more than one person. You’ll need this information if you use the
10-year tax option (Form 4972). If you previously received an annuity
contract as part of a distribution (or the contract was purchased
through a direct rollover from a plan account) and periodic payments
from that annuity contract are included in box 1, the value of the
contract as of the end of the year is shown. This information may be
provided to your plan administrator to determine any required
distribution from that plan. If charges were made for qualified longterm care insurance contracts under combined arrangements, the
amount of the reduction in the investment (but not below zero) in the
annuity or life insurance contract is reported here.
Box 9a. Your percentage is shown if a total distribution was made to
more than one person.
Box 9b. For a life annuity from a qualified plan or from a section
403(b) plan (with after-tax contributions), an amount may be shown for
the employee’s total investment in the contract. It is used to compute
the taxable part of the distribution. See Pub. 575.
Box 10. If an amount is reported in this box, see the Instructions for
Form 5329 and Pub. 575.
Box 11. The first year you made a contribution to the designated Roth
account reported on this form is shown in this box.
Box 12. If checked, the payer is reporting on this Form 1099 to satisfy
its Internal Revenue Code chapter 4 account reporting requirement
under FATCA. You may also have a filing requirement. See the
Instructions for Form 8938.
Box 13. Shows the date of payment for reportable death benefits
under section 6050Y.
Boxes 14–19. If state or local income tax was withheld from the
distribution, boxes 16 and 19 may show the part of the distribution
subject to state and/or local tax.
Additional information. You may want to see: Form W-4P,
Form 4972, Form 5329, Form 8606, Pub. 525, Pub. 560, Pub. 571,
Pub. 575, Pub. 590-A, Pub. 590-B, Pub. 721, Pub. 939, and Pub. 969.

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Instructions for Recipient (continued)