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Copy A of this form is provided for (IRS)

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The Internal Revenue Service (IRS) is a government agency responsible for collecting taxes and administering the federal statutory tax laws of the United States. The IRS provide tax assistance to taxpayers and pursue and resolve fraudulent tax filings.

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Attention:
Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded and printed and used to satisfy the requirement to provide the information to
the recipient.
To order official IRS information returns, which include a scannable Copy A for filing with
the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on
Employer and Information Returns, and we’ll mail you the forms you request and their
instructions, as well as any publications you may order.
Information returns may also be filed electronically using the IRS Filing Information Returns
Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act
Information Returns (AIR) program (visit www.IRS.gov/AIR).
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
Form 1098-F
(Rev. January 2022)
Cat. No. 71382B
Fines, Penalties, and
Other Amounts
Department of the Treasury - Internal Revenue Service
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
OMB No. 1545-2284
For Privacy Act and
Paperwork Reduction
Act Notice, see the
current General
Instructions for
Certain Information
Returns.
0303
For calendar year
20
VOID CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
FILER’S TIN PAYER’S TIN
PAYER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1
Total amount required to be paid
$
2 Amount to be paid for
violation or potential violation
$
3 Restitution/remediation
amount
$
4 Compliance amount
$
5 Date of order/agreement
6 Court or entity
7 Case number
8
Case name or names of parties to suit, order, or agreement
9 Code
Form 1098-F (Rev. 1-2022)
www.irs.gov/Form1098F
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1098-F
(Rev. January 2022)
Fines, Penalties, and
Other Amounts
Department of the Treasury - Internal Revenue Service
Copy B
For Payer
This is important tax
information and is
being furnished to
the IRS.
OMB No. 1545-2284
For calendar year
20
CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
FILER’S TIN PAYER’S TIN
PAYER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1
Total amount required to be paid
$
2 Amount to be paid for
violation or potential violation
$
3 Restitution/remediation
amount
$
4 Compliance amount
$
5 Date of order/agreement
6 Court or entity
7 Case number
8
Case name or names of parties to suit, order, or agreement
9 Code
Form 1098-F (Rev. 1-2022)
(keep for your records) www.irs.gov/Form1098F
Instructions for Payer
This statement has been furnished to you by a government,
governmental entity, or nongovernmental entity regarding a suit, court
order, or an agreement with respect to a violation or potential violation
of law. Retain this statement for your records.
Payer’s taxpayer identification number (TIN). For your protection,
this form may show only the last four digits of your TIN (social security
number (SSN), individual taxpayer identification number (ITIN),
adoption taxpayer identification number (ATIN), or employer
identification number (EIN)). However, the issuer has reported your
complete TIN to the IRS.
Box 1. Shows the aggregate amount required to be paid under the
suit, order, or agreement if the amount equals or exceeds $50,000.
Box 2. Shows the total amount required to be paid in relation to the
violation or potential violation of law as stated in the suit, order, or
agreement.
Box 3. Shows the amount identified in the suit, order, or agreement to
be paid as restitution or remediation.
Box 4. Shows the amount identified in the suit, order, or agreement to
be paid to come into compliance with a law.
Box 5. Shows the date the suit, order, or agreement became binding
under applicable law.
Box 6. Shows the name of the court, or any other entity, that entered
the order or approved the agreement, if applicable.
Box 7. Shows the case number associated with the order or an
agreement, if applicable.
Box 8. Provides a case name or names of the parties to the suit,
order, or agreement.
Box 9. Code.
A—Multiple payments.
B—Multiple payers.
C—Multiple payees.
D—Provision of services or provision of property required.
E—Payment amount not identified.
Future developments. For the latest information about developments
related to Form 1098-F and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/Form1098F.
Free File Program. Go to www.irs.gov/FreeFile to see if you qualify
for no-cost online federal tax preparation, e-filing, and direct deposit
or payment options.
Form 1098-F
(Rev. January 2022)
Fines, Penalties, and
Other Amounts
Department of the Treasury - Internal Revenue Service
Copy C
For Filer
OMB No. 1545-2284
For Privacy Act and
Paperwork Reduction
Act Notice, see the
current General
Instructions for
Certain Information
Returns.
For calendar year
20
VOID CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
FILER’S TIN PAYER’S TIN
PAYER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1
Total amount required to be paid
$
2 Amount to be paid for
violation or potential violation
$
3 Restitution/remediation
amount
$
4 Compliance amount
$
5 Date of order/agreement
6 Court or entity
7 Case number
8
Case name or names of parties to suit, order, or agreement
9 Code
Form 1098-F (Rev. 1-2022)
www.irs.gov/Form1098F
Instructions for Filer
To complete Form 1098-F, use:
• The current General Instructions for Certain
Information Returns, and
• The current Instructions for Form 1098-F.
To order these instructions and additional forms, go
to www.irs.gov/EmployerForms.
Caution: Because paper forms are scanned during
processing, you cannot file certain Forms 1096, 1097,
1098, 1099, 3921, or 5498 that you download and print
from the IRS website.
Filing and furnishing. For filing and furnishing
instructions, including due dates, and to request filing
or furnishing extensions, see the current General
Instructions for Certain Information Returns.
Need help? If you have questions about reporting on
Form 1098-F, call the information reporting customer
service site toll free at 866-455-7438 or 304-263-8700
(not toll free). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).
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Completed 18 December 2021

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