Form 1096
Attention filers of Form 1096:
This form is provided for informational purposes only. It appears in red, similar to the official
IRS form. The official printed version of this IRS form is scannable, but a copy, printed from
this website, is not. Do not print and file a Form 1096 downloaded from this website; a
penalty may be imposed for filing with the IRS information return forms that can’t be
scanned. See part O in the current General Instructions for Certain Information Returns,
available at www.irs.gov/form1099, for more information about penalties.
To order official IRS information returns, which include a scannable Form 1096 for filing with
the IRS, visit www.IRS.gov/orderforms
. Click on Employer and Information Returns, and
we’ll mail you the forms you request and their instructions, as well as any publications you
may order.
Information returns may also be filed electronically. To file electronically, you must have
software, or a service provider, that will create the file in the proper format. More information
can be found at:
•
IRS Filing Information Returns Electronically (FIRE) system (visit
www.IRS.gov/FIRE
), or
• IRS Affordable Care Act Information Returns (AIR) program (visit www.IRS.gov/AIR
).
See IRS Publications 1141, 1167, and 1179 for more 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
2017
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
1
Employer identification number
2 Social security number3 Total number of forms4 Federal income tax withheld
$
5
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
32
1097-BTC
50
1098
81
1098-C
78
1098-E
84
1098-Q
74
1098-T
83
1099-A
80
1099-B
79
1099-C
85
1099-CAP
73
1099-DIV
91
1099-G
86
1099-INT
92
1099-K
10
1099-LTC
93
1099-MISC
95
1099-OID
96
1099-PATR
97
1099-Q
31
1099-QA
1A
1099-R
98
1099-S
75
1099-SA
94
3921
25
3922
26
5498
28
5498-ESA
72
5498-QA
2A
5498-SA
27
7 Form 1099-MISC with NEC in box 7, check.....
▶
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
▶
Title
▶
Date
▶
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 electronicallyfiling
information returns listed on this form in box 6 with the IRS isthrough
the FIRE system. See Pub. 1220.
Purpose of form. Use this form to transmit paper Forms 1097,1098,
1099, 3921, 3922, 5498, and W-2G to the Internal RevenueService.
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 2017 General Instructions for Certain InformationReturns.
Forms 1099-QA and 5498-QA can be filed on paper only, regardless
of the number of 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
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 28, 2018.
Caution: File Form 1099-MISC by January 31, 2018, if you are
reporting nonemployee compensation in box 7. Also, check box 7
above.
• With Forms 5498, file by May 31, 2018.
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
▲▲
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 2017 General Instructions for Certain Information Returns.
Cat. No. 14400O
Form 1096 (2017)
Form 1096 (2017)
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-E with a Form 1096 and you have
correctly completed two Forms 1098-E on that page, enter “2” in box
3 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 6
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-QA
Box 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-QABoxes 1 and 2
Form 5498-SABox 1
Corrected returns. For information about filing corrections, see the
2017 General Instructions for Certain Information Returns. Originals
and corrections of the same type of return can be submitted using
one Form 1096.
