Federal Free Printable 2016 Form 1099-QA for 2017 Federal Distributions from ABLE Accounts

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Distributions from ABLE Accounts
2016 Form 1099-QA

VOID 1A1A CORRECTED 1 Gross distribution PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. $ 2 Earnings PAYER’S federal identification no. RECIPIENT’S social security number Form 1099-QA 3 Basis 4 Program-to-program transfer 5 Check if ABLE account terminated in 2016 Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) Form 1099-QA Cat. No. 67554X 2016 $ $ RECIPIENT’S name OMB No. 1545-2262 www.irs.gov/form1099qa 6 Check if the recipient is not the designated beneficiary Distributions from ABLE Accounts Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page CORRECTED (if checked) 1 Gross distribution PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. $ 2 Earnings PAYER’S federal identification no. RECIPIENT’S social security number Form 1099-QA 3 Basis 4 Program-to-program transfer 5 If checked, ABLE account terminated in 2016 Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) Form 1099-QA (keep for your records) 2016 $ $ RECIPIENT’S name OMB No. 1545-2262 www.irs.gov/form1099qa 6 If this box is checked, the recipient is not the designated beneficiary Distributions from ABLE Accounts Copy B For Recipient This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported. Department of the Treasury - Internal Revenue Service Instructions for Recipient Recipient's taxpayer identification number. For your protection, this form may show only the last four digits of your SSN, ITIN, or ATIN. However, the payer has reported your complete identification number to the IRS. Account number. May show an account or other unique number the payer has assigned to distinguish your account. Box 1. Shows the gross distribution paid to you this year from an Achieving a Better Life Experience (ABLE) savings account. Box 2. Shows the earnings part of the gross distribution shown in box 1. Generally, amounts distributed that are used to pay for qualified disability expenses, or rolled over to another ABLE account within 60 days, are not included in income. Report taxable amounts as “Other Income” on Form 1040. Also see Form 5329 and its separate instructions. Box 3. Shows your basis in the gross distribution reported in box 1. Box 4. This box is checked if a program-to-program transfer was made from this ABLE account to another ABLE account. Box 5. This box is checked if the ABLE account was terminated in 2016. Box 6. The designated beneficiary is the individual named in the document creating the ABLE account to receive the benefit of the funds in the account. If this box is checked, you (the recipient) are not the designated beneficiary of this ABLE account. You and/or the designated beneficiary may be subject to additional taxes and/or penalties on the box 1 gross distribution. See Form 5329 and its separate instructions and the Instructions for Form 1040 (line 21, “Other income”). VOID CORRECTED 1 Gross distribution PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. $ 2 Earnings PAYER’S federal identification no. RECIPIENT’S social security number Form 1099-QA 3 Basis 4 Program-to-program transfer 5 Check if ABLE account terminated in 2016 Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) Form 1099-QA 2016 $ $ RECIPIENT’S name OMB No. 1545-2262 www.irs.gov/form1099qa 6 Check if the recipient is not the designated beneficiary Distributions from ABLE Accounts Copy C For Payer For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. Department of the Treasury - Internal Revenue Service Instructions for Payer To complete Form 1099-QA, use: • the 2016 General Instructions for Certain Information Returns, and • the 2016 Instructions for Form 1099-QA. To order these instructions and additional forms, go to www.irs.gov/form1099qa. Due dates. Furnish Copy B of this form to the recipient by January 31, 2017. File Copy A of this form with the IRS by February 28, 2017. Need help? If you have questions about reporting on Form 1099-QA, call the information reporting customer service site toll free at 1-866-455-7438 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).
Extracted from PDF file 2016-federal-form-1099-qa.pdf, last modified November 2015

More about the Federal Form 1099-QA Other TY 2016

We last updated the Distributions from ABLE Accounts in May 2017, so this is the latest version of Form 1099-QA, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 1099-QA directly from TaxFormFinder. You can print other Federal tax forms here.

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The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 1099-QA from the Internal Revenue Service in May 2017.

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Historical Past-Year Versions of Federal Form 1099-QA

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2016 Form 1099-QA

2016 Form 1099-QA

Distributions from ABLE Accounts 2015 Form 1099-QA

2016 Form 1099-QA


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