CT TEACHERS’ RETIREMENT BOARD
165 CAPITOL AVENUE, HARTFORD, CT 06106-1673
Toll Free 1-800-504-1102 Local (959) 867-6333 Fax (860) 241-9295
“An Affirmative Action/Equal Opportunity Employer”
www.ct.gov/trb
REQUEST FOR A DUPLICATE IRS 1099R FORM
Copy of 1099R for Tax Year(s): ____________________ SSN: _______________________________________
Member Name: __________________________________ Address: ____________________________________
Email: __________________________________________ City: _____________ State: ______ Zip: ________
Select one of the following three options. Please allow 5 business days for processing this request.
Email a copy of my 1099-R to email address above. This will update the email account TRB
has on file. A secure email will be sent along with detailed instructions on how to view the
email. Please check your junk/spam folders if you have not received a response.
Mail a copy of my 1099-R to address above. This will update the mailing address on file if the
address is different from what TRB has on file. Please allow an additional 3-5 business days
for delivery.
Forward a copy of my 1099-R to a
temporary or tax preparer’s address.
This will not update what TRB has on file.
Choose one from the following options:
□Email □Mail □Fax
Name: ____________________________________
Address: _______________________________
City, State, Zip: __________________________
Email: __________________________________
Fax: ___________________________________
Member Signature: _______________________________ Date: _________________________
Submit this form to TRB by either:
Mail: Teachers’ Retirement Board
165 Capitol Avenue
Hartford, CT 06106-1673
Fax: (860) 241-9295
Attention: TRB Fiscal Division
1099R Request Form (011519)
RT_1099R_200713
