IT-1099-UI
New York State Department of Taxation and Finance
Summary of Unemployment
Compensation Payments
Please file this original scannable form with the Tax Department.
File Form IT-1099-UI as an entire page.
Taxpayer’s rst name and middle initial Taxpayer’s last name
Spouse’s rst name and middle initial Spouse’s last name
Your social security number
Spouse’s social security number
This Form IT-1099-UI is for ( mark an X in one box ): ...................... Taxpayer Spouse
Box a Payer’s name and full address
New York State
Department of Labor-Unemployment Insurance
Albany, NY 12240-0001
Box b
Payer’s federal identication number State New York State tax withheld
N Y 2 7 0 2 9 3 1 1 7
Box 1 Unemployment compensation
Instructions
General instructions
Who must file this form — If you are required to le a New
York State income tax return and you (or your spouse, if ling
jointly) received federal Form(s) 1099-G statements issued by
the New York State Department of Labor showing New York
State income tax withheld, you must complete Form IT-1099-UI.
You should complete Form IT-1099-UI only if the federal
Form 1099-G was issued by the New York State Department of
Labor and shows New York State withholding.
How to complete Form IT-1099-UI — You must complete
one Form IT-1099-UI for each federal Form 1099-G you (and if
ling jointly, your spouse) received that shows New York State
income tax withheld. Enter only the information requested on
Form IT-1099-UI.
Each box on Form IT-1099-UI corresponds to a similarly
named or numbered box on the federal Form 1099-G that you
received from the New York State Department of Labor. Enter
the information provided on your federal Form 1099-G in the
corresponding boxes on Form IT-1099-UI.
Specific instructions
Enter your name and social security number and, if married,
your spouse’s name and social security number in the
appropriate boxes.
If you are the recipient of federal Form 1099-G, mark an X in the
Taxpayer box. If your spouse is the recipient, mark an X in the
Spouse box.
Box 1 — Enter the unemployment compensation shown in
Box 1 of federal Form 1099-G.
New York State tax withheld — Enter the New York State
income tax withheld as shown on federal Form 1099-G issued
by the New York State Department of Labor.
Total the New York State tax withheld amount(s) from all
IT-1099-UI form(s). Include this total on the Total New York State
tax withheld line on your New York State income tax return.
File Form IT-1099-UI as an entire page. Attach this form
(IT-1099-UI) to your New York State income tax return,
Form IT-201 or IT-203. Do not attach your federal 1099-G
form(s); keep them for your records.
