Form 1096 - Annual Summary And Transmittal Of U.s. Information Returns - 2016 Page 2

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6969
Do Not Staple
1096
OMB No. 1545-0108
Annual Summary and Transmittal of
Form
16
20
U.S. Information Returns
Department of the Treasury
Internal Revenue Service
FILER'S name
Street address (including room or suite number)
City or town, state or province, country, and ZIP or foreign postal code
For Official Use Only
Name of person to contact
Telephone number
Email address
Fax number
1 Employer identification number 2 Social security number
3 Total number of forms
4 Federal income tax withheld
5 Total amount reported with this Form 1096
$
$
6 Enter an “X” in only one box below to indicate the type of form being filed.
7 Form 1099-MISC with NEC in box 7, check
.
.
.
.
.
W-2G
1097-BTC
1098
1098-C
1098-E
1098-Q
1098-T
1099-A
1099-B
1099-C
1099-CAP
1099-DIV
1099-G
1099-INT
1099-K
32
50
81
78
84
74
83
80
79
85
73
91
86
92
10
1099-LTC
1099-MISC
1099-OID
1099-PATR
1099-Q
1099-QA
1099-R
1099-S
1099-SA
3921
3922
5498
5498-ESA
5498-QA
5498-SA
93
95
96
97
31
1A
98
75
94
25
26
28
72
2A
27
Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct,
and complete.
Signature
Title
Date
Instructions
When to file. File Form 1096 as follows.
• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by
Future developments. For the latest information about developments
February 28, 2017.
related to Form 1096, such as legislation enacted after it was
Caution: File Form 1099-MISC by January 31, 2017, if you are
published, go to
reporting nonemployee compensation in box 7. Also, check box 7
Reminder. The only acceptable method of filing the information
above.
returns listed on this form in box 6 electronically with the Internal
• With Forms 5498, file by May 31, 2017.
Revenue Service is through the FIRE system. See Pub. 1220.
Where To File
Purpose of form. Use this form to transmit paper Forms 1097, 1098,
1099, 3921, 3922, 5498, and W-2G to the Internal Revenue Service.
Send all information returns filed on paper with Form 1096 to the
following.
Caution: If you are required to file 250 or more information returns of
any one type, you must file electronically. If you are required to file
If your principal business, office
electronically but fail to do so, and you do not have an approved
Use the following
or agency, or legal residence in
waiver, you may be subject to a penalty. For more information, see
three-line address
the case of an individual, is
part F in the 2016 General Instructions for Certain Information Returns.
located in
Forms 1099-QA and 5498-QA can be filed on paper only,
regardless of the number of returns.
Alabama, Arizona, Arkansas,
Connecticut, Delaware, Florida, Georgia,
Who must file. The name, address, and TIN of the filer on this form
Kentucky, Louisiana, Maine,
must be the same as those you enter in the upper left area of Forms
Department of the Treasury
Massachusetts, Mississippi, New
1097, 1098, 1099, 3921, 3922, 5498, or W-2G. A filer is any person or
Internal Revenue Service Center
Hampshire, New Jersey, New Mexico,
Austin, TX 73301
entity who files any of the forms shown in line 6 above.
New York, North Carolina, Ohio,
Enter the filer’s name, address (including room, suite, or other unit
Pennsylvania, Rhode Island, Texas,
Vermont, Virginia, West Virginia
number), and TIN in the spaces provided on the form.
1096
Cat. No. 14400O
For more information and the Privacy Act and Paperwork Reduction Act Notice,
Form
(2016)
see the 2016 General Instructions for Certain Information Returns.

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