IRS Form 1099-G – Certain Government Payments

Please fill out all of the information below from your IRS form. If there is nothing in the box on your form, just leave the field blank. Round all amounts to the nearest dollar (no cents).

Email Address*
Corrected
- Yes
Payer's Name
First Last
Payer's Federal ID #
Payer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Payer's Phone
Recipient's Name
Recipients Identification #
Recipient's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Acct.# (optional)
1. Unemployment compensation
2. State or local income tax refunds, credits, or offsets
3. Box 2 amount is for tax year
4. Federal income tax withheld
5. ATAA/RTAA payments
6. Taxable grants
7. Agriculture payments
9. Market gain
8. If checked, box 2 is trade or business income
10a. State
10b. State identification no.
11. State income tax withheld
Special Notes
CAPTCHA