Fillable Printable 2010 Form 1096
Fillable Printable 2010 Form 1096
2010 Form 1096
6969Do Not Staple
OMB No. 1545-0108
Annual Summary and Transmittal of
U.S. Information Returns
Form 1096
Department of the Treasury
Internal Revenue Service
FILER’S name
Street address (including room or suite number)
City, state, and ZIP code
For Official Use Only
Telephone number
()
Total number of
forms
31
Employer identification number
5
Total amount reported with this Form 1096
4
Federal income tax withheld
2 Social security number
$$
Enter an “X” in only one box below to indicate the type of form being filed. If this is your final return, enter an “X” here
1098-T
83
1098-E
84
1099-OID
96
1099-SA
94
1099-MISC
95
1099-LTC
93
1099-H
71
1099-G
86
1099-DIV
91
1099-B
79
1099-A
80
1098
81
W-2G
32
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.
Date
Title
Signature
Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Instructions
Reminder. The only acceptable method of filing information returns
with Enterprise Computing Center—Martinsburg (ECC—MTB) is
electronically through the FIRE system. See Pub. 1220,
Specifications for Filing Forms 1098, 1099, 3921, 3922, 5498, 8935,
and W-2G Electronically.
Preaddressed Form 1096. If you received a preaddressed Form
1096 from the IRS with Package 1096, use it to transmit paper
Forms 1098, 1099, 3921, 3922, 5498, and W-2G to the Internal
Revenue Service. If any of the preprinted information is incorrect,
make corrections on the form.
If you are not using a preaddressed form, enter the filer’s name,
address (including room, suite, or other unit number), and TIN in the
spaces provided on the form.
For more information and the Privacy Act and Paperwork Reduction Act Notice,
see the 2010 General Instructions for Certain Information Returns.
Form 1096 (2010)
1099-C
85
5498-ESA
72
5498
28
1099-S
75
1099-R
98
1099-PATR
97
Name of person to contact
()
Email address Fax number
Alabama, Arizona, Arkansas, Connecticut, Delaware,
Florida, Georgia, Kentucky, Louisiana, Maine,
Massachusetts, Mississippi, New Hampshire,
New Jersey, New Mexico, New York, North Carolina,
Ohio, Pennsylvania, Rhode Island, Texas, Vermont,
Virginia, West Virginia
Department of the Treasury
Internal Revenue Service Center
Austin, TX 73301
Where To File
Use the following
three-line address
If your principal business,
office or agency, or legal
residence in the case of an
individual, is located in
Send all information returns filed on paper with Form 1096 to the
following:
Cat. No. 14400O
1099-Q
31
5498-SA
27
1099-INT
92
1099-CAP
73
1098-C
78
6 7
Purpose of form. Use this form to transmit paper Forms 1098,
1099, 3921, 3922, 5498, and W-2G to the Internal Revenue Service.
Do not use Form 1096 to transmit electronically. For electronic
submissions, see Pub. 1220, Specifications for Filing Forms 1098,
1099, 3921, 3922, 5498, 8935, and W-2G Electronically.
When to file. File Form 1096 as follows.
● With Forms 1098, 1099, 3921, 3922, or W-2G, file by
February 28, 2011.
● With Forms 5498, 5498-ESA, or 5498-SA, file by May 31, 2011.
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 2010 General Instructions for Certain Information
Returns.
Who must file. 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
1098, 1099, 3921, 3922, 5498, or W-2G. A filer is any person or
entity who files any of the forms shown in line 6 above.
20
10
3921
25
3922
26
Page
2
Form 1096 (2010)
Final return. If you will not be required to file Forms 1098, 1099,
3921, 3922, 5498, or W-2G in the future, either on paper or
electronically, enter an “X” in the “final return” box.
Corrected returns. For information about filing corrections, see the
2010 General Instructions for Certain Information Returns. Originals
and corrections of the same type of return can be submitted using
one Form 1096.
Printed on recycled paper
Form 1098 Boxes 1, 2, and 4
Form 1099-B Boxes 2 and 3
Form 1099-C
Boxes 1a, 2a, 3, 8, and 9Form 1099-DIV
Box 1Form 1099-H
Boxes 1, 2, 3, 5, 6, 7, 8, 10, 13, and 14Form 1099-MISC
Boxes 1, 2, and 6Form 1099-OID
Boxes 1, 2, 3, and 5Form 1099-PATR
Box 1Form 1099-R
Box 2Form 1099-S
Boxes 1, 2, 3, 4, 5, 8, 9, 10, 12b, 13a,
and 14a
Form 5498
Box 2
Boxes 1 and 2Form 1099-LTC
Box 1Form 1099-SA
Box 1Form 5498-SA
Box 5. No entry is required if you are filing Forms 1099-A or 1099-G.
For all other forms, enter the total of the amounts from the specific
boxes of the forms listed below.
Box 1Form W-2G
Box 1Form 1098-E
Box 1 or 2. Complete only if you are not using a preaddressed Form
1096. Make an entry 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 Forms 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 with a Form 1096 and you have
correctly completed two Forms 1098 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.
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 1Form 1099-Q
Boxes 1, 3, and 8Form 1099-INT
Boxes 1 and 2Form 5498-ESA
Form 1099-CAP Box 2
Boxes 1, 2, 4, 5, 6, and 10Form 1098-T
Form 1098-C Box 4c
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.
Alaska, California, Colorado, District of Columbia,
Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas,
Maryland, Michigan, Minnesota, Missouri, Montana,
Nebraska, Nevada, North Dakota, Oklahoma,
Oregon, South Carolina, South Dakota, Tennessee,
Utah, Washington, Wisconsin, Wyoming
Department of the Treasury
Internal Revenue Service Center
Kansas City, MO 64999
Form 3921 Boxes 3 and 4
Form 3922 Boxes 3, 4, and 5
