Fillable Printable 2015 Form 1096

2015 Form 1096

Attention:

This form is provided for informational purposes only. Copy A appears in red, similar to the

official IRS form. Do not file copy A downloaded from this website. The official printed

version of this IRS form is scannable, but the online version of it, printed from this website,

is not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the

current General Instructions for Certain Information Returns for more information about

penalties.

To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or

Order Information

Returns and Employer Returns Online, and we’ll mail you the scannable forms and other

products.

See IRS Publications 1141, 1167, 1179 and other IRS resources for information about

printing these tax forms.

Do Not Staple

6969

Form 1096

Department of the Treasury

Internal Revenue Service

Annual Summary and Transmittal of

U.S. Information Returns

OMB No. 1545-0108

2015

FILER'S name

Street address (including room or suite number)

City or town, state or province, country, and ZIP or foreign postal code

Name of person to contactTelephone number

Email addressFax number

For Official Use Only

Employer identification number

2 Social security number3 Total number of forms4 Federal income tax withheld

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

1097-BTC

1098

1098-C

1098-E

1098-Q

1098-T

1099-A

1099-B

1099-C

1099-CAP

1099-DIV

1099-G

1099-INT

1099-K

1099-LTC

1099-MISC

1099-OID

1099-PATR

1099-Q

1099-R

1099-S

1099-SA

3921

3922

5498

5498-ESA

5498-SA

7 If this is your final return, enter an “X” here .....

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Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.

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.

Signature

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Title

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Date

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Instructions

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 filing information returns

with Internal Revenue Service/Information Returns Branch is

electronically through the FIRE system. See Pub. 1220,Specifications

for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922, 5498,and

W-2G.

Purpose of form. Use this form to transmit paper Forms 1097,1098,

1099, 3921, 3922, 5498, and W-2G to the Internal RevenueService.

Do not use Form 1096 to transmit electronically. Forelectronic

submissions, see Pub. 1220.

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 2015 General Instructions for Certain InformationReturns.

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

1097, 1098, 1099, 3921, 3922, 5498, or W-2G. A filer is any personor

entity who files any of the forms shown in line 6 above.

Enter the filer’s name, address (including room, suite, or other unit

number), and TIN in the spaces provided on the form.

When to file. File Form 1096 as follows.

• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February

29, 2016.

• With Forms 5498, file by May 31, 2016.

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

three-line address

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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

For more information and the Privacy Act and Paperwork Reduction Act Notice,

see the 2015 General Instructions for Certain Information Returns.

Cat. No. 14400O

Form 1096 (2015)

Page 2

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

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.

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.) containingsummary

(subtotal) information with Form 1096. Summaryinformation for the

group of forms being sent is entered only inboxes 3, 4, and 5 of Form

1096.

Box 1 or 2. Make an entry in either box 1 or 2; not both. Individuals

not ina trade or business must enter their social security number

(SSN) inbox 2; sole proprietors and all others must enter their

employeridentification number (EIN) in box 1. However, sole

proprietors whodo not have an EIN must enter their SSN in box 2.

Use the same EINor SSN on Form 1096 that you use on Forms 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 with a Form 1096 and you havecorrectly

completed two Forms 1098 on that page, enter “2” in box3 of Form

1096.

Box 4. Enter the total federal income tax withheld shown on theforms

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, enter the total of the amounts from the

specific boxes of the forms listed below.

Form W-2GBox 1

Form 1097-BTCBox 1

Form 1098Boxes 1 and 2

Form 1098-CBox 4c

Form 1098-EBox 1

Form 1098-Q

Box 4

Form 1099-BBoxes 1d and 13

Form 1099-CBox 2

Form 1099-CAPBox 2

Form 1099-DIVBoxes 1a, 2a, 3, 8, 9, and 10

Form 1099-INTBoxes 1, 3, 8, 10, 11, and 13

Form 1099-KBox 1a

Form 1099-LTCBoxes 1 and 2

Form 1099-MISCBoxes 1, 2, 3, 5, 6, 7, 8, 10, 13, and 14

Form 1099-OIDBoxes 1, 2, 5, 6, and 8

Form 1099-PATRBoxes 1, 2, 3, and 5

Form 1099-QBox 1

Form 1099-RBox 1

Form 1099-SBox 2

Form 1099-SABox 1

Form 3921Boxes 3 and 4

Form 3922Boxes 3, 4, and 5

Form 5498Boxes 1, 2, 3, 4, 5, 8, 9, 10, 12b, 13a,

and 14a

Form 5498-ESABoxes 1 and 2

Form 5498-SABox 1

Final return. If you will not be required to file Forms 1097, 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

2015 General Instructions for Certain Information Returns. Originals

and corrections of the same type of return can be submitted using

one Form 1096.