Form Ct-1096 (Drs)- Connecticut Annual Summary And Transmittal Of Information Returns

Department of Revenue Services

2011

PO Box 5081

Form CT-1096 (DRS)

Hartford, CT 06102-5081

(Rev. 01/11)

Connecticut Annual Summary and Transmittal of Information Returns

form.

Electronic Filing Requirements - Read instructions on back before completing this

General Instructions

Where to File

Complete this return in blue or black ink only.

Use the Taxpayer Service Center (TSC) to

electronically ﬁ le this return. See TSC on back.

If you are not required to ﬁ le federal Form 1096, you are not required

If ﬁ ling by paper, mail your completed return and

to ﬁ le Form CT-1096 (DRS). Special rules apply to designated

every copy 1 of federal Form 1096, 1099-MISC, 1099-R, or W-2G

withholding agents. See Policy Statement 2009(1), Income Tax

to the address on the return below.

Withholding for Athletes or Entertainers.

Group the forms by form number and send each group with a

Form CT-1096 (DRS) may be used by new payers or payers who

separate Form CT-1096.

have not received their 2011 Connecticut Payer of Nonpayroll

Amounts Withholding Returns and Instructions.

Line Instructions

Line 1: Enter Connecticut income tax withheld from Connecticut

See Informational Publication 2011(8), Connecticut Tax Guide for

nonpayroll amounts during the calendar year. This should equal the

Payers of Nonpayroll Amounts.

Total Line on the back of this return.

When to File

Line 2: Enter total:

If filing electronically, Form CT-1096 is due the last day of

• Connecticut Lottery winnings paid to resident and nonresident

March 2012. Do not mail Form CT-1096 (DRS) if you are ﬁ ling

individuals, as reported on federal Form W-2G, whether or not

electronically. If ﬁ ling by paper, Form CT-1096 (DRS) is due the last

Connecticut income tax was withheld;

day of February 2012.

• Other gambling winnings paid to resident individuals, as reported

If the due date falls on a Saturday, Sunday, or legal holiday, the next

on federal Form W-2G, whether or not Connecticut income tax

business day is the due date. See Who Must File Form CT-1096

was withheld;

(DRS) on back page.

• Miscellaneous payments reported on federal Form 1099-MISC to

Rounding Off to Whole Dollars

resident individuals or to nonresident individuals if the payments

You must round off cents to the nearest whole dollar on your returns

relate to services performed wholly or partly in Connecticut even

and schedules. If you do not round, the Department of Revenue

if no Connecticut income tax was withheld; and

Services (DRS) will disregard the cents.

• Distributions from pensions, annuities, retirement, or

Round down to the next lowest dollar all amounts that include

proﬁ t-sharing plans, as reported on federal Form 1099-R, but

1 through 49 cents. Round up to the next highest dollar all amounts

only if Connecticut income tax was withheld.

that include 50 through 99 cents. However, if you need to add two

Line 3: Enter the number of 1099-MISC, 1099-R, or W-2G forms

or more amounts to compute the amount to enter on a line, include

submitted with this return.

cents and round off only the total.

Complete all required information on the front and back of this return.

Example: Add two amounts ($1.29 + $3.21) to compute the total

Sign and date the return in the space provided.

($4.50) to enter on a line. $4.50 is rounded to $5.00 and entered

Do not make a payment with this return.

on the line.



Separate here and mail

return

to DRS. Make a copy for your records.



2011

CT-1096 (DRS)

Connecticut Annual Summary and Transmittal of Information Returns

Connecticut Tax Registration Number

Federal Employer ID Number

Calendar year ending

Due date



February 29,

2012

Enter name and address below. Please print or type.

1. Connecticut income tax withheld from

Name



Connecticut nonpayroll amounts

2. Total nonpayroll amounts reported



with Form CT-1096

Address

3. Number of 1099-MISC, 1099-R, or



W-2Gs submitted

City

State

ZIP code

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,

imprisonment for not more than ﬁ ve years, or both.

Do not send payment with this return.

Mail to:

Department of Revenue Services

Signature _____________________________________________________________

State of Connecticut

PO Box 5081

Hartford CT 06102-5081

Title _____________________________________ Date ____________________

Form Ct-1096 (Drs)- Connecticut Annual Summary And Transmittal Of Information Returns - 2011

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