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Department of Revenue Services

2013

PO Box 5081

Form CT-1096 (DRS)

Hartford, CT 06102-5081

(Rev. 12/12)

Connecticut Annual Summary and Transmittal of Information Returns

Complete this return in blue or black ink only.

Electronic Filing Requirements - Read instructions on back before completing this

form.

Where to File

General Instructions

Use the Taxpayer Service Center (TSC) to electronically ﬁ le this

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

return. See TSC on back.

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

withholding agents. See Policy Statement 2011(2), Income Tax

If ﬁ ling by paper, mail your completed return and every copy 1 of

Withholding for Athletes or Entertainers.

federal Form 1099-MISC, 1099-R, or W-2G to the address on the

return below.

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

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

have not received their 2013 Connecticut Payer of Nonpayroll

separate Form CT-1096.

Amounts Withholding Returns and Instructions.

Line Instructions

See Informational Publication 2013(8), Connecticut Tax Guide for

Payers of Nonpayroll Amounts.

Line 1: Enter Connecticut income tax withheld from Connecticut

nonpayroll amounts during the calendar year. This should equal the

When to File

Total Line on the back of this return.

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

Line 2: Enter total:

March 2014. Do not mail Form CT-1096 (DRS) if you are ﬁ ling

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

• Connecticut Lottery winnings paid to resident and nonresident

day of February 2014.

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

Connecticut income tax was withheld;

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

• Other gambling winnings paid to resident individuals, as reported

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

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

(DRS) on back page.

was withheld;

Rounding Off to Whole Dollars

• Miscellaneous payments reported on federal Form 1099-MISC to

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

resident individuals or to nonresident individuals if the payments

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

relate to services performed wholly or partly in Connecticut even

Services (DRS) will disregard the cents.

if no Connecticut income tax was withheld; and

Round down to the next lowest dollar all amounts that include

• Distributions from pensions, annuities, retirement, or

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

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

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

only if Connecticut income tax was withheld.

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

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

cents and round off only the total.

submitted with this return.

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

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

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

Sign and date the return in the space provided.

on the line.

Do not make a payment with this return.



Separate here and mail

return

to DRS. Make a copy for your records.



2013

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 28, 2014

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 - 2013

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