Fillable Printable Form1099G2010
Fillable Printable Form1099G2010
Form1099G2010
T
A
B
L
E
A
T
A
B
L
E
B
COPYB
FORRECIPIENT
EmploymentDevelopmentDepa rtment
Payer'sFedera lIDNo.94-2650401
ThisisimportanttaxinformationandisbeingfurnishedtotheInternalRevenueService(IRS).Ifyouarerequiredtofileareturn,anegligence
penaltyorothersanctionmaybeimposedonyouifthisincomeistaxableandtheIRSdeterminesthatithasnotbeenreported.
FORM1099GCERTAINGOVERNMENTPAYMENTS
REPORTOFTAXABLEUNEMPLOYMENTCOMP ENSATIONPAYMENTSFROMTHESTATEOFCALIFORNIA
3.Box2AmountisForTaxYear
2010Bene fitsRepa id
(a)
$0.00
PriorYear(s)BenefitsRepaid
(b)
$0.00
OMBNO.1545-0120
2010
Form1099GRev.27
SocialSe curityNumber
4.FederalIncome
Recipient'sName
2.StateorLocalIncomeTax
TypeofUCPayments
$0.00
UnemploymentInsuranceIntegrityandAccounting
Division-MIC16A
P.O.Box2408
RanchoCordova,CA95741-2408
$0.00
1.UnemploymentCompensation(UC)
Refunds,Credits,orOffsetsTaxWithheld
PRESORTED
FIRST-CLASSMAIL
U.S.POSTAGEPAID
SACRAMENTO,CA
PERMI TNO.800
POBox826880,Sacramento ,CA94280-0001
OFFICIALBUSINESS
PENALTYFORPRIVATEUSE$300
COPYB
FORRECIPIENT
EmploymentDevelopmentDepartment
Payer'sFedera lIDNo.94-2650401
$0.00
ThisisimportanttaxinformationandisbeingfurnishedtotheIRS.Ifyouarerequiredt ofileareturn,anegligencepenaltyorothersanctionmay
beimposedonyouifthisincomeistaxableandtheIRSdeterminesthatithasnotbeenreported.
FORM1099GCERTAINGOVERNMENTPAYMENTS
REPORTOFTAXABLEUNEMPLOYMENTCOMPENSATION-PAIDFAMILYLEAVEPAYMENTSFROMTHE
STATEOFCALIFORNIA
3.Box2AmountisForTaxYear
2010Bene fitsRepa id
(a)
$0.0
PriorYear(s)BenefitsRepaid
(b)
$0.00
OMBNO.1545-0120
2010
Form1099GRev.27
SocialSe curityNumber
4.FederalIncome
Recipient'sName
2.StateorLocalIncomeTax
PFLPayments
$0.
UnemploymentInsuranceIntegrityandAccounting
Division-MIC16A
P.O.Box2408
RanchoCordova,CA95741-2408
Leave(UC-PFL)
$0.00
1.UnemploymentCompensation-PaidFamily
Refunds,Credits,orOffsetsTaxWithheld
*SeeReverseSideforEasyOpeningInstructions*
ImportantTaxInformation
Keepforyourrecords
StateDisab ilityInsura nce(SDI)contributio nswithheldma ybede ductiblefo rta xpayerswhoitemizetheirde ductio nsforfederalinco me
taxpurposes.Forassistance,calltheIRSat1-800-829-1040.
BOX1TotalTAXABLEUnemploymentCompensation(UC)paidtoyoubytheEmploymentDevelopmentDepartment.
Theamountshownincludesallpayment(s)withissuedate(s)withinthecalendaryear2010.
BOX4Federa lIncomeTaxwithheldfromtaxableUCpa idtoyo uin2010bytheEmploym entDev elopmentDepa rtment.
TypeofUCpayments(mayincludeamountswithheldforchildsupportobligation):
UI-Unem ploymentInsurance
DUA-DisasterUnemploymentAssistance
DI-DisabilityInsurancepaida sasubstituteforUIbe nefitstoanindividualwhoisineligibleforUIas
aresultofadisa bility.Thesebe n efitsaretaxableandreportedasUCinaccorda ncewithFederal
Ta xRegulationsSe ction1.85-1.
Benefitsrepaidduringcalendaryear2010.
(a)Amo untsyo upaidonaben efito verpa yme ntforaclaimfiledin2010.
(b)Amountsyoupaidonabenefitoverpaymentforaclaimfiledinprioryears.
Theamountsreporteddonotincludepenalties,interest,orothercosts.
T
A
B
L
E
A1
PaidFa milyLea veInsurance(PFL)contributionswithheldma ybedeductiblefortax payerswhoitem izetheirde ductionsforfede ralincome
taxpurposes.Forassistance,calltheIRSat1-800-829-1040.
BOX1TotalTAXABLEUnemploymentCompensation-PaidFamilyLeave(UC-PFL)paidtoyoubytheEmploymentDevelopment
Department.
Theamountshownincludesallpayment(s)withissuedate(s)withinthecalendaryear2010.
IfyoudidnotreceivePFLpayments,Box1ofTableBwilldisplay$0.00.
BOX4FederalIncomeTaxwithhelddo esnotapplytoPFLpa yments.
PFLpayments(mayincludeamountswithheldforchildsupportobligation):
PFL-PaidFamilyLeaveInsurance.ThesebenefitsaretaxableandreportableinaccordancewithSections61
and85o ftheInterna lRevenueCode .
Benefitsrepaidduringcalendaryear2010.
(a)Amo untsyo upaidonaben efito verpa yme ntforaclaimfiledin2010.
(b)Amountsyoupaidonabenefitoverpaymentforaclaimfiledinprioryears.
Theamountsreporteddonotincludepenalties,interest,orothercosts.
T
A
B
L
E
B1
PLEASEREADTHEFOLLOWINGINSTRUCTIONS:
THEAMOUNTINBOX1OFTABLEAANDTABLEBISCONSIDEREDTAXABLEINCOMEUNDERFEDERAL
LAW.Therefore,thisam ountshouldbereportedasincomei fyouarerequiredtofileafeder alincometaxreturn.Table
A1orB1explai nsthei nformationineachboxofTabl eAorTableB.
Ifyouhavequestionsonhowtor eportunempl oymentcompensation,benefit srepaid,orincometaxwi thheld,callthe
IRSat1-800-829-1040.
Ifyoudisagreewiththeam ountsshowninTableAorTableB,callthe1099Gcustomerservicelineat1-866-401-2849:
GeneralInfor mati on:AutomatedSystemavailable24hoursdaily,7daysperweek.
CustomerService:Weekdays.....................8a.m.-5p.m .
Formoreinformationyoucanvi sitourWebsiteathttp://www.edd.ca.gov/Unemployment /FAQ_for_1099G.htm
Paramásinformación,favordevisitarnuestrositi oweben
htt p://www.edd.ca. gov/Unemployment/FAQ_for_1099G_en_Espanol.htm
Siud.noestádeacuerdoconlacantidadqueapareceenlaTabla" A"oTabla"B",llamealosencargadosdel
formular io1099GalalíneadeServiciosalClienteal1-866-401- 2849 .
