Fillable Printable Form 1099G Certain Government Payments.
Fillable Printable Form 1099G Certain Government Payments.
Form 1099G Certain Government Payments.
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PO Box 826880, Sacramento, CA 94280-0001
OFFICIAL BUSINESS
PENALTY FOR PRIVATE USE $300
Important Tax Information - Keep for your records.
*See Reverse Side for Easy Opening Instructions*
You may qualify for the Earned Income Tax Credit (EITC) depending on your
annual earnings. The EITC is a refundable federal income tax credit available to
low to moderate income working individuals and families. The EITC has no effect
on eligibility for Medicaid, Supplemental Security Income, food stamps, or most
other temporary assistance for those in need. Even if you do not owe federal
taxes, you must file a tax return to receive the EITC. For more information
regarding your eligibility for the EITC, or to obtain the necessary forms to apply for
this refundable tax credit, visit the Internal Revenue Service (IRS) website at
www.irs.gov/eitc
or contact the IRS by telephone.
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FOR RECIPIENT
FORM 1099G CERTAIN GOVERNMENT PAYMENTS
REPORT OF TAXABLE UNEMPLOYMENT COMPENSATION PAYMENTS FROM THE STATE OF CALIFORNIA
OMB NO. 1545-0120
2016
Form 1099G Rev. 33
Employment Development Department Recipient's Name Social Security Number
Unemployment Insurance Integrity and Accounting
Division - MIC 16A
P.O. Box 2408
Rancho Cordova, CA 95741-2408
Payer's Federal ID No. 94-2650401
2. State or Local Income Tax 3. Box 2 Amount is for Tax Year 4. Federal Income
1. Unemployment Compensation (UC)
Refunds, Credits, or Offsets Tax Withheld
Type of UC Payments 2016 Benefits Repaid
(a)
Prior Year(s) Benefits Repaid
(b)
This is important tax information and is being furnished to the Internal Revenue Service (IRS). If you are required to file a return, a negligence
penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
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FOR RECIPIENT
FORM 1099G CERTAIN GOVERNMENT PAYMENTS
REPORT OF TAXABLE UNEMPLOYMENT COMPENSATION-PAID FAMILY LEAVE PAYMENTS FROM THE
STATE OF CALIFORNIA
OMB NO. 1545-0120
2016
Form 1099G Rev. 33
Employment Development Department Recipient's Name Social Security Number
Unemployment Insurance Integrity and Accounting
Division - MIC 16A
P.O. Box 2408
Rancho Cordova, CA 95741-2408
Payer's Federal ID No. 94-2650401
2. State or Local Income Tax 3. Box 2 Amount is for Tax Year 4. Federal Income
1. Unemployment Compensation-Paid Family
Refunds, Credits, or Offsets Tax Withheld
Leave (UC-PFL)
$0.00
PFL Payments 2016 Benefits Repaid
(a)
Prior Year(s) Benefits Repaid
(b)
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 this income is taxable and the IRS determines that it has not been reported.
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