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Department of Revenue Services

Form CT-1096

2016

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

day.

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.

2016

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

Name

1. Connecticut income tax





.00

withheld from Connecticut

nonpayroll amounts

Address (number and street)

PO Box

2. Total nonpayroll amounts

.00





reported with Form CT-1096

City, town, or post ofﬁ ce

State

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.

Signature

Title

Date

_____________________________________________________________

____________________________________

_______________________________

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

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