Fillable Form 1099-R Distributions

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Form 1099-R Distributions

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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 1099-R
2020
Cat. No. 14436Q
Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0119
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2020 General
Instructions for
Certain
Information
Returns.
9898
VOID CORRECTED
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and phone no.
PAYER’S TIN RECIPIENT’S TIN
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
$
2a Taxable amount
$
2b Taxable amount
not determined
Total
distribution
3 Capital gain (included
in box 2a)
$
4 Federal income tax
withheld
$
5
Employee contributions/
Designated Roth
contributions or
insurance premiums
$
6 Net unrealized
appreciation in
employer’s securities
$
7 Distribution
code(s)
IRA/
SEP/
SIMPLE
8 Other
$
%
9a
Your percentage of total
distribution
%
9b
Total employee contributions
$
10 Amount allocable to IRR
within 5 years
$
11
1st year of desig.
Roth contrib.
12 FATCA filing
requirement
13 Date of
payment
14 State tax withheld
$
$
15
State/Payer’s state no.
16 State distribution
$
$
17 Local tax withheld
$
$
18 Name of locality 19 Local distribution
$
$
Form 1099-R
www.irs.gov/Form1099R
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-R
2020
Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.
Department of the Treasury - Internal Revenue Service
Copy 1
For
State, City,
or Local
Tax Department
OMB No. 1545-0119
VOID CORRECTED
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and phone no.
PAYER’S TIN RECIPIENT’S TIN
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
$
2a Taxable amount
$
2b Taxable amount
not determined
Total
distribution
3 Capital gain (included
in box 2a)
$
4 Federal income tax
withheld
$
5
Employee contributions/
Designated Roth
contributions or
insurance premiums
$
6 Net unrealized
appreciation in
employer’s securities
$
7 Distribution
code(s)
IRA/
SEP/
SIMPLE
8 Other
$
%
9a
Your percentage of total
distribution
%
9b
Total employee contributions
$
10 Amount allocable to IRR
within 5 years
$
11
1st year of desig.
Roth contrib.
12 FATCA filing
requirement
13 Date of
payment
14 State tax withheld
$
$
15
State/Payer’s state no.
16 State distribution
$
$
17 Local tax withheld
$
$
18 Name of locality 19 Local distribution
$
$
Form 1099-R
www.irs.gov/Form1099R
Form 1099-R
2020
Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.
Copy B
Report this
income on your
federal tax
return. If this
form shows
federal income
tax withheld in
box 4, attach
this copy to
your return.
Department of the Treasury - Internal Revenue Service
This information is
being furnished to
the IRS.
OMB No. 1545-0119
CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and phone no.
PAYER’S TIN RECIPIENT’S TIN
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
$
2a Taxable amount
$
2b Taxable amount
not determined
Total
distribution
3 Capital gain (included
in box 2a)
$
4 Federal income tax
withheld
$
5
Employee contributions/
Designated Roth
contributions or
insurance premiums
$
6 Net unrealized
appreciation in
employer’s securities
$
7 Distribution
code(s)
IRA/
SEP/
SIMPLE
8 Other
$
%
9a
Your percentage of total
distribution
%
9b
Total employee contributions
$
10 Amount allocable to IRR
within 5 years
$
11
1st year of desig.
Roth contrib.
12 FATCA filing
requirement
13 Date of
payment
14 State tax withheld
$
$
15
State/Payer’s state no.
16 State distribution
$
$
17 Local tax withheld
$
$
18 Name of locality 19 Local distribution
$
$
Form 1099-R
www.irs.gov/Form1099R
Instructions for Recipient
Generally, distributions from retirement plans (IRAs, qualified plans,
section 403(b) plans, and governmental section 457(b) plans),
insurance contracts, etc., are reported to recipients on Form 1099-R.
Qualified plans and section 403(b) plans. If your annuity starting
date is after 1997, you must use the simplified method to figure your
taxable amount if your payer didn’t show the taxable amount in box
2a. See the instructions for your tax return.
IRAs. For distributions from a traditional individual retirement
arrangement (IRA), simplified employee pension (SEP), or savings
incentive match plan for employees (SIMPLE), generally the payer isn’t
required to compute the taxable amount. See the instructions for your
tax return to determine the taxable amount. If you’re at least age 70½
by the end of 2019 (age 72 by the end of later years), you must take
minimum distributions from your IRA (other than a Roth IRA). If you
don’t, you’re subject to a 50% excise tax on the amount that
should’ve been distributed. See Pub. 590-A and Pub. 590-B for more
information on IRAs.
Roth IRAs. For distributions from a Roth IRA, generally the payer isn’t
required to compute the taxable amount. You must compute any
taxable amount on Form 8606. An amount shown in box 2a may be
taxable earnings on an excess contribution.
Loans treated as distributions.
If you borrow money from a qualified
plan, section 403(b) plan, or governmental section 457(b) plan, you may
have to treat the loan as a distribution and include all or part of the
amount borrowed in your income. There are exceptions to this rule. If
your loan is taxable, code L will be shown in box 7. See Pub. 575.
Recipient’s taxpayer identification number (TIN). For your
protection, this form may show only the last four digits of your TIN
(SSN, ITIN, ATIN, or EIN). However, the payer has reported your
complete TIN to the IRS.
Account number. May show an account, policy, or other unique
number the payer assigned to distinguish your account.
Box 1. Shows the total amount you received this year. The amount
may have been a direct rollover, a transfer or conversion to a Roth
IRA, a recharacterized IRA contribution; or you may have received it
as periodic payments, nonperiodic payments, or a total distribution.
Report the amount on Form 1040, 1040-SR, or 1040-NR on the line
for “IRAs, pensions, and annuities” (or the line for “Taxable amount”)
and on Form 8606, as applicable. However, if this is a lump-sum
distribution, see Form 4972. If you haven’t reached minimum
retirement age, report your disability payments on the line for “Wages,
salaries, tips, etc.” on your tax return. Also report on that line
permissible withdrawals from eligible automatic contribution
arrangements and corrective distributions of excess deferrals, excess
contributions, or excess aggregate contributions except if the
distribution is of designated Roth contributions or your after-tax
contributions or if you’re self-employed.
If a life insurance, annuity, qualified long-term care, or endowment
contract was transferred tax free to another trustee or contract issuer,
an amount will be shown in this box and code 6 will be shown in box
7. If a charge or payment was made against the cash value of an
annuity contract or the cash surrender value of a life insurance
contract for the purchase of qualified long-term care insurance, an
amount will be shown in this box and code W will be shown in box 7.
You need not report these amounts on your tax return. If code C is
shown in box 7, the amount shown in box 1 is a receipt of reportable
death benefits that is taxable in part.
Box 2a. This part of the distribution is generally taxable. If there is no
entry in this box, the payer may not have all the facts needed to figure
the taxable amount. In that case, the first box in box 2b should be
checked. You may want to get one of the free publications from the IRS
to help you figure the taxable amount. See Additional information on the
back of Copy 2. For an IRA distribution, see IRAs and Roth IRAs, earlier.
For a direct rollover, other than from a qualified plan, sec. 403(b) plan,
or governmental sec. 457(b) plan to a designated Roth account in the
same plan or to a Roth IRA, zero should be shown and you must enter
zero (-0-) on the “Taxable amount” line of your tax return. If you roll over
a distribution (other than a distribution from a designated Roth account)
from a qualified plan, sec. 403(b) plan, or governmental sec. 457(b) plan
to a designated Roth account in the same plan or to a Roth IRA,
(Continued on the back of Copy C)
Form 1099-R
2020
Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.
Copy C
For Recipient’s
Records
Department of the Treasury - Internal Revenue Service
This information is
being furnished to
the IRS.
OMB No. 1545-0119
CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and phone no.
PAYER’S TIN RECIPIENT’S TIN
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
$
2a Taxable amount
$
2b Taxable amount
not determined
Total
distribution
3 Capital gain (included
in box 2a)
$
4 Federal income tax
withheld
$
5
Employee contributions/
Designated Roth
contributions or
insurance premiums
$
6 Net unrealized
appreciation in
employer’s securities
$
7 Distribution
code(s)
IRA/
SEP/
SIMPLE
8 Other
$
%
9a
Your percentage of total
distribution
%
9b
Total employee contributions
$
10 Amount allocable to IRR
within 5 years
$
11
1st year of desig.
Roth contrib.
12 FATCA filing
requirement
13 Date of
payment
14 State tax withheld
$
$
15
State/Payer’s state no.
16 State distribution
$
$
17 Local tax withheld
$
$
18 Name of locality 19 Local distribution
$
$
Form 1099-R
(keep for your records) www.irs.gov/Form1099R
Instructions for Recipient (continued)
you must include on the “Taxable amount” line of your tax return the
amount shown in this box plus the amount in box 6, if any.
If this is a total distribution from a qualified plan and you were born
before January 2, 1936 (or you’re the beneficiary of someone born
before January 2, 1936), you may be eligible for the 10-year tax
option. See the Form 4972 instructions for more information.
If you’re an eligible retired public safety officer who elected to
exclude from income distributions from your eligible plan used to pay
certain insurance premiums, the amount shown in box 2a hasn’t been
reduced by the exclusion amount. See the instructions for your tax
return for more information.
Box 2b. If the first box is checked, the payer was unable to determine
the taxable amount and box 2a should be blank, except for an IRA.
It’s your responsibility to determine the taxable amount. If the second
box is checked, the distribution was a total distribution that closed out
your account.
Box 3. If you received a lump-sum distribution from a qualified plan
and were born before January 2, 1936 (or you’re the beneficiary of
someone born before January 2, 1936), you may be able to elect to
treat this amount as a capital gain on Form 4972 (not on Schedule D
(Forms 1040 and 1040-SR)). See the Form 4972 instructions. For a
charitable gift annuity, report as a long-term capital gain as explained
in the Instructions for Form 8949.
Box 4. Shows federal income tax withheld. Include this amount on
your income tax return as tax withheld, and if box 4 shows an amount
(other than zero), attach Copy B to your return. Generally, if you
receive payments that aren’t eligible rollover distributions, you can
change your withholding or elect not to have income tax withheld by
giving the payer Form W-4P.
Box 5. Generally, this shows the employee’s investment in the
contract (after-tax contributions), if any, recovered tax free this year;
the portion that’s your basis in a designated Roth account; the part of
premiums paid on commercial annuities or insurance contracts
recovered tax free; the nontaxable part of a charitable gift annuity; or
the investment in a life insurance contract reportable under section
6050Y. This box doesn’t show any IRA contributions. If the amount
shown is your basis in a designated Roth account, the year you first
made contributions to that account may be entered in box 11.
Box 6. If you received a lump-sum distribution from a qualified plan
that includes securities of the employer’s company, the net unrealized
appreciation (NUA) (any increase in value of such securities while in
the trust) is taxed only when you sell the securities unless you choose
to include it in your gross income this year. See Pub. 575 and
Form 4972. If you roll over the distribution to a designated Roth
account in the same plan or to a Roth IRA, see the instructions for box
2a. For a direct rollover to a designated Roth account in the same plan
or to a Roth IRA, the NUA is included in box 2a. If you didn’t receive a
lump-sum distribution, the amount shown is the NUA attributable to
employee contributions, which isn’t taxed until you sell the securities.
Box 7. The following codes identify the distribution you received. For
more information on these distributions, see the instructions for your
tax return. Also, certain distributions may be subject to an additional
10% tax. See the Instructions for Form 5329.
1—Early distribution, no known exception (in most cases, under age
59½).
2—Early distribution, exception applies (under age 59½).
3—Disability.
4—Death.
5—Prohibited transaction.
6—Section 1035 exchange (a tax-free exchange of life insurance,
annuity, qualified long-term care insurance, or endowment
contracts).
7—Normal distribution.
8—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2020.
9—Cost of current life insurance protection.
A—May be eligible for 10-year tax option (see Form 4972).
B—Designated Roth account distribution.
Note: If code B is in box 7 and an amount is reported in box 11,
see the Instructions for Form 5329.
C—Reportable death benefits under section 6050Y.
D—Annuity payments from nonqualified annuities that may be subject
to tax under section 1411.
E—Distributions under Employee Plans Compliance Resolution
System (EPCRS).
(Continued on the back of Copy 2)
Form 1099-R
2020
Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.
Copy 2
File this copy
with your state,
city, or local
income tax
return, when
required.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0119
CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and phone no.
PAYER’S TIN RECIPIENT’S TIN
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
$
2a Taxable amount
$
2b Taxable amount
not determined
Total
distribution
3 Capital gain (included
in box 2a)
$
4 Federal income tax
withheld
$
5
Employee contributions/
Designated Roth
contributions or
insurance premiums
$
6 Net unrealized
appreciation in
employer’s securities
$
7 Distribution
code(s)
IRA/
SEP/
SIMPLE
8 Other
$
%
9a
Your percentage of total
distribution
%
9b
Total employee contributions
$
10 Amount allocable to IRR
within 5 years
$
11
1st year of desig.
Roth contrib.
12 FATCA filing
requirement
13 Date of
payment
14 State tax withheld
$
$
15
State/Payer’s state no.
16 State distribution
$
$
17 Local tax withheld
$
$
18 Name of locality 19 Local distribution
$
$
Form 1099-R
www.irs.gov/Form1099R
Instructions for Recipient (continued)
F—Charitable gift annuity.
G—Direct rollover of a distribution to a qualified plan, a section 403(b)
plan, a governmental section 457(b) plan, or an IRA.
H—Direct rollover of a designated Roth account distribution to a Roth
IRA.
J—Early distribution from a Roth IRA, no known exception (in most
cases, under age 59½).
K—Distribution of traditional IRA assets not having a readily available
FMV.
L—Loans treated as distributions.
M—Qualified plan loan offset.
N—Recharacterized IRA contribution made for 2020 and
recharacterized in 2020.
P—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2019.
Q—Qualified distribution from a Roth IRA.
R—Recharacterized IRA contribution made for 2019 and
recharacterized in 2020.
S—Early distribution from a SIMPLE IRA in first 2 years, no known
exception (under age 59½).
T—Roth IRA distribution, exception applies.
U—Dividend distribution from ESOP under section 404(k).
Note: This distribution isn’t eligible for rollover.
W—Charges or payments for purchasing qualified long-term care
insurance contracts under combined arrangements.
If the IRA/SEP/SIMPLE box is checked, you’ve received a traditional
IRA, SEP, or SIMPLE distribution.
Box 8. If you received an annuity contract as part of a distribution, the
value of the contract is shown. It isn’t taxable when you receive it and
shouldn’t be included in boxes 1 and 2a. When you receive periodic
payments from the annuity contract, they’re taxable at that time. If the
distribution is made to more than one person, the percentage of the
annuity contract distributed to you is also shown. You’ll need this
information if you use the 10-year tax option (Form 4972). If charges
were made for qualified long-term care insurance contracts under
combined arrangements, the amount of the reduction in the
investment (but not below zero) in the annuity or life insurance
contract is reported here.
Box 9a. If a total distribution was made to more than one person, the
percentage you received is shown.
Box 9b. For a life annuity from a qualified plan or from a section
403(b) plan (with after-tax contributions), an amount may be shown for
the employee’s total investment in the contract. It is used to compute
the taxable part of the distribution. See Pub. 575.
Box 10. If an amount is reported in this box, see the Instructions for
Form 5329 and Pub. 575.
Box 11. The first year you made a contribution to the designated Roth
account reported on this form is shown in this box.
Box 12. If box 12 is checked, the payer is reporting on this Form 1099
to satisfy its chapter 4 account reporting requirement under FATCA.
You may also have a filing requirement. See the Instructions for Form
8938.
Box 13. Shows the date of payment for reportable death benefits
under section 6050Y.
Boxes 14–19. If state or local income tax was withheld from the
distribution, boxes 16 and 19 may show the part of the distribution
subject to state and/or local tax.
Additional information. You may want to see:
Form W-4P, Form 4972, Form 5329, Form 8606
Pub. 525, Taxable and Nontaxable Income
Pub. 560, Retirement Plans for Small Business
Pub. 571, Tax-Sheltered Annuity Plans
Pub. 575, Pension and Annuity Income
Pub. 590-A, Contributions to IRAs
Pub. 590-B, Distributions from IRAs
Pub. 721, U.S. Civil Service Retirement Benefits
Pub. 939, General Rule for Pensions and Annuities
Pub. 969, HSAs and Other Tax-Favored Health Plans
Form 1099-R
2020
Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing Plans,
IRAs, Insurance
Contracts, etc.
Copy D
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0119
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2020 General
Instructions for
Certain
Information
Returns.
VOID CORRECTED
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and phone no.
PAYER’S TIN RECIPIENT’S TIN
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
$
2a Taxable amount
$
2b Taxable amount
not determined
Total
distribution
3 Capital gain (included
in box 2a)
$
4 Federal income tax
withheld
$
5
Employee contributions/
Designated Roth
contributions or
insurance premiums
$
6 Net unrealized
appreciation in
employer’s securities
$
7 Distribution
code(s)
IRA/
SEP/
SIMPLE
8 Other
$
%
9a
Your percentage of total
distribution
%
9b
Total employee contributions
$
10 Amount allocable to IRR
within 5 years
$
11
1st year of desig.
Roth contrib.
12 FATCA filing
requirement
13 Date of
payment
14 State tax withheld
$
$
15
State/Payer’s state no.
16 State distribution
$
$
17 Local tax withheld
$
$
18 Name of locality 19 Local distribution
$
$
Form 1099-R
www.irs.gov/Form1099R
Instructions for Payer
To complete Form 1099-R, use:
• The 2020 General Instructions for Certain
Information Returns, and
• The 2020 Instructions for Forms 1099-R and
5498.
To order these instructions and additional
forms, go to www.irs.gov/Form1099R.
Caution: Because paper forms are scanned
during processing, you cannot file Forms
1096, 1097, 1098, 1099, 3921, or 5498 that
you print from the IRS website.
Due dates. Furnish Copies B, C, and 2 of this
form to the recipient by February 1, 2021.
File Copy A of this form with the IRS by
March 1, 2021. If you file electronically, the
due date is March 31, 2021. To file
electronically, you must have software that
generates a file according to the specifications
in Pub. 1220. The IRS does not provide a fill-in
form option for Copy A.
Need help? If you have questions about
reporting on Form 1099-R, 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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Form 1099-R Distributions

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Completed 26 February 2020

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