Instructions For Forms 3921 And 3922 (Rev. August 2013)
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1
2Instructions for Forms 3921
Department of the Treasury
Internal Revenue Service
and 3922
(Rev. August 2013)
Excercise of an Incentive Stock Option Under Section 422(b) and Transfer of Stock
Acquired Through an Employee Stock Purchase Plan Under Section 423(c)
Section references are to the Internal Revenue Code
Any party in control of the payment of remuneration for
unless otherwise noted.
employment to the employee.
Future Developments
Statements to Transferees
For the latest information about developments related to
If you are required to file Form 3921, you must furnish a
Forms 3921 and 3922 and their instructions, such as
statement to the person whose name is set forth on Form
legislation enacted after they were published, go to
3921. For more information, see part M in the current
or
version of the General Instructions for Certain Information
Returns.
Reminder
Employee's Name, Address, and Identification
In addition to these specific instructions, you should also
use the current version of the General Instructions for
Number
Certain Information Returns. Those general instructions
Enter the name, address, and identifying number of the
include information about the following topics.
person to whom the share or shares were transferred
Who must file (nominee/middleman).
pursuant to the exercise of the option.
When and where to file.
Account Number
Electronic reporting requirements.
Corrected and void returns.
The account number is required if you have multiple
Statements to recipients.
accounts for a person for whom you are filing more than
Taxpayer identification numbers.
one Form 3921. Additionally, the IRS encourages you to
Backup withholding.
designate an account number for all Forms 3921 that you
Penalties.
file. See part L in the current version of the General
Other general topics.
Instructions for Certain Information Returns.
You can get the general instructions at
Box 1. Date Option Granted
form3921
or
form3922
or by calling
Enter the date the option was granted.
1-800-TAX-FORM (1-800-829-3676).
Box 2. Date Option Exercised
Specific Instructions for Form 3921
Enter the date the option was exercised.
Who Must File
Box 3. Exercise Price Per Share
Every corporation which in any calendar year transfers to
Enter the exercise price per share of stock.
any person a share of stock pursuant to that person's
exercise of an incentive stock option described in section
Box 4. Fair Market Value Per Share on Exercise
422(b) must, for that calendar year, file Form 3921 for
Date
each transfer made during that year.
Enter the fair market value (FMV) per share of stock on
Exception. A Form 3921 is not required for the exercise
the date the option was exercised.
of an incentive stock option by an employee who is a
Box 5. Number of Shares Transferred
nonresident alien (as defined in section 7701(b)) and to
whom the corporation is not required to provide a Form
Enter the number of shares of stock transferred pursuant
W-2, Wage and Tax Statement, for any calendar year
to the exercise of the option.
within the time period beginning with the first day of the
Box 6. If Other Than TRANSFEROR, Name,
calendar year in which the option was granted to the
employee and ending on the last day of the calendar year
Address, and EIN of Corporation Whose Stock
in which the employee exercised the option. For this
Is Being Transferred
purpose, the term “corporation” is defined in section
Enter the name, address, and employer identification
7701(a) and includes, but is not limited to:
number (EIN) of the corporation whose stock is being
The corporation issuing the stock,
transferred pursuant to the exercise of the option. Enter
A related corporation of the corporation,
this information only if the corporation is not the entity
Any agent of the corporation,
shown in the TRANSFEROR boxes in the upper left
Any party distributing shares of stock or other payments
corner of Form 3921.
in connection with the plan (for example, a brokerage
firm), and
Jul 24, 2013
Cat. No. 23069T
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