Form Ct-1096 - Connecticut Annual Summary And Transmittal Of Information Returns - 2016


Department of Revenue Services
Form CT-1096
State of Connecticut
Connecticut Annual Summary and
PO Box 5081
Hartford CT 06102-5081
Transmittal of Information Returns
(Rev. 10/16)
Electronic reporting requirements are available at
General Instructions
and Informational Publication
If you are not required to fi le federal Form 1096, you are
2016(12), Form 1099-R, 1099-MISC and W-2G Electronic
not required to fi le Form CT-1096. Special rules apply to
Filing Requirements for Tax Year 2016.
designated withholding agents. See Policy Statement
Waiver of Electronic Filing Requirement
2015(5), Income Tax Withholding for Athletes or Entertainers.
File Form CT-1096 electronically. See Electronic Filing
To request a waiver from the information return electronic fi ling
Requirement, below.
requirement complete Form CT-8508, Request for Waiver
from Filing Information Returns Electronically, at least 30
See Informational Publication 2016(8), Connecticut Tax
days before the due date.
Guide for Payers of Nonpayroll Amounts.
If a waiver is granted, your information returns must be
Do not make a payment with this return.
submitted to DRS on compact disk by the last day of February.
When to File
See Form CT-4804, Transmittal of Information Returns
Reported on Compact Disc (CD) for Forms W-2G, 1099-R,
If fi ling electronically, Form CT-1096 is due March 31, 2017.
and 1099-MISC.
Do not mail Form CT-1096 if you are fi ling electronically.
If fi ling by paper, Form CT-1096 is due February 28, 2017.
Who Must File Form CT-1096
If the due date falls on a Saturday, Sunday, or legal holiday,
If you are required to fi le federal Form 1096, you must fi le
the return will be considered timely if fi led by the next business
Form CT-1096 with DRS even if you are not required to be
registered with DRS, and submit every state copy of:
• Federal Form W-2G for (1) Connecticut Lottery winnings
Electronic Filing Requirement
paid to resident and nonresident individuals even if no
If you fi le 25 or more Forms 1099-MISC, 1099-R, or W-2G
Connecticut income tax was withheld; and (2) other
you are required to fi le electronically unless you have been
gambling winnings paid to resident individuals even if no
granted a waiver from electronic fi ling of information returns.
Connecticut income tax was withheld;
See Waiver of Electronic Filing Requirement, on this page.
• Federal Form 1099-MISC for payments made to resident
If you fi le 24 or fewer Forms 1099-MISC, 1099-R, or W-2G
individuals or to nonresident individuals if the payments
you are encouraged to fi le electronically but may fi le paper
relate to services performed wholly or partly in Connecticut
forms without requesting a waiver.
even if no Connecticut income tax was withheld; and
Use the Taxpayer Service Center (TSC) to
• Federal Form 1099-R reporting distributions from pensions,
electronically fi le this return. See Taxpayer
annuities, retirement, or profi t sharing plans, but only if
Service Center (TSC), on back.
Connecticut income tax was withheld.
Complete this return in blue or black ink only.
Separate here and mail return to DRS. Make a copy for your records.
Do not mail this form if fi ling electronically.
Department of Revenue Services
Form CT-1096
PO Box 5081
Connecticut Annual Summary and
Hartford CT 06102-5081
(Rev. 10/16)
Transmittal of Information Returns
1096 1016W 01 9999
Connecticut Tax Registration Number
Federal Employer ID Number
Due date
February 28, 2017
1. Connecticut income tax
withheld from Connecticut
nonpayroll amounts
Address (number and street)
PO Box
2. Total nonpayroll amounts
reported with Form CT-1096
City, town, or post offi ce
ZIP code
3. Number of 1099-MISC, 1099-R,
or W-2Gs submitted
I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of
my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document to DRS is
a fi ne of not more than $5,000, or imprisonment for not more than fi ve years, or both.


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