Federal Free Printable 2016 Form 1099-R for 2017 Federal Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.

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Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
2016 Form 1099-R

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. VOID 9898 CORRECTED PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code OMB No. 1545-0119 1 Gross distribution 2a Taxable amount 2016 $ Form $ 2b Taxable amount not determined PAYER’S federal identification number RECIPIENT’S identification number Total distribution 3 Capital gain (included in box 2a) $ /Designated Roth contributions or insurance premiums $ withheld Copy A For Internal Revenue Service Center File with Form 1096. 6 Net unrealized appreciation in employer’s securities For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. $ 7 Distribution code(s) Street address (including apt. no.) 4 Federal income tax $ 5 Employee contributions RECIPIENT’S name 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. IRA/ SEP/ SIMPLE 8 Other $ City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total distribution 10 Amount allocable to IRR within 5 years 11 1st year of desig. Roth contrib. FATCA filing requirement $ 12 State tax withheld 1099-R Cat. No. 14436Q 16 Name of locality 17 Local distribution $ $ www.irs.gov/form1099r Do Not Cut or Separate Forms on This Page 13 State/Payer’s state no. 14 State distribution $ $ $ $ Form $ $ $ 15 Local tax withheld Account number (see instructions) % % 9b Total employee contributions — Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code OMB No. 1545-0119 1 Gross distribution 2a Taxable amount 2016 $ Form $ 2b Taxable amount not determined PAYER’S federal identification number RECIPIENT’S identification number Total distribution 3 Capital gain (included in box 2a) $ /Designated Roth contributions or insurance premiums $ withheld For State, City, or Local Tax Department 6 Net unrealized appreciation in employer’s securities $ 7 Distribution code(s) Street address (including apt. no.) 4 Federal income tax Copy 1 $ 5 Employee contributions RECIPIENT’S name 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. IRA/ SEP/ SIMPLE 8 Other $ City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total distribution 10 Amount allocable to IRR within 5 years 11 1st year of desig. Roth contrib. FATCA filing requirement $ 12 State tax withheld $ $ Form 1099-R www.irs.gov/form1099r $ 13 State/Payer’s state no. 14 State distribution $ $ 15 Local tax withheld Account number (see instructions) % % 9b Total employee contributions $ $ 16 Name of locality 17 Local distribution $ $ Department of the Treasury - Internal Revenue Service CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code OMB No. 1545-0119 1 Gross distribution 2a Taxable amount 2016 $ Form $ 2b Taxable amount not determined PAYER’S federal identification number RECIPIENT’S identification number 3 Capital gain (included in box 2a) 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. 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) Street address (including apt. no.) Copy B Total distribution $ RECIPIENT’S name 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. IRA/ SEP/ SIMPLE 8 Other This information is being furnished to the Internal Revenue Service. $ City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total distribution 10 Amount allocable to IRR within 5 years 11 1st year of desig. Roth contrib. FATCA filing requirement $ 12 State tax withheld $ $ Form 1099-R www.irs.gov/form1099r $ 13 State/Payer’s state no. 14 State distribution $ $ 15 Local tax withheld Account number (see instructions) % % 9b Total employee contributions $ $ 16 Name of locality 17 Local distribution $ $ Department of the Treasury - Internal Revenue Service Instructions for Recipient Generally, distributions from pensions, annuities, profit-sharing and retirement plans (including section 457 state and local government plans), IRAs, insurance contracts, etc., are reported to recipients on Form 1099-R. Qualified plans. If your annuity starting date is after 1997, you must use the simplified method to figure your taxable amount if your payer did not show the taxable amount in box 2a. See the instructions for Form 1040, 1040A, or 1040NR. 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 is not required to compute the taxable amount. See the Form 1040, 1040A, or 1040NR instructions to determine the taxable amount. If you are at least age 70½, you must take minimum distributions from your IRA (other than a Roth IRA). If you do not, you are subject to a 50% excise tax on the amount that should have 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 is not 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 identification number. For your protection, this form may show only the last four digits of your 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 identification number to the IRS. FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for Form 8938. Account number. May show an account 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, as nonperiodic payments, or as a total distribution. Report the amount on Form 1040, 1040A, or 1040NR on the line for “IRA distributions” or “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 have not 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 are 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. 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 on this page. For a direct rollover, other than from a qualified plan 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 (Continued on the back of Copy C.) CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code OMB No. 1545-0119 1 Gross distribution 2a Taxable amount 2016 $ Form $ 2b Taxable amount not determined PAYER’S federal identification number RECIPIENT’S identification number Total distribution 3 Capital gain (included in box 2a) $ /Designated Roth contributions or insurance premiums $ For Recipient's Records 4 Federal income tax withheld 6 Net unrealized appreciation in employer’s securities $ 7 Distribution code(s) Street address (including apt. no.) Copy C $ 5 Employee contributions RECIPIENT’S name 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. IRA/ SEP/ SIMPLE 8 Other This information is being furnished to the Internal Revenue Service. $ City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total distribution 10 Amount allocable to IRR within 5 years 11 1st year of desig. Roth contrib. $ Account number (see instructions) FATCA filing requirement 12 State tax withheld 1099-R (keep for your records) $ 13 State/Payer’s state no. 14 State distribution $ $ 15 Local tax withheld $ $ Form % % 9b Total employee contributions www.irs.gov/form1099r $ $ 16 Name of locality 17 Local distribution $ $ Department of the Treasury - Internal Revenue Service Instructions for Recipient (Continued) distribution (other than a distribution from a designated Roth account) from a qualified plan (including a governmental section 457(b) plan) or section 403(b) plan to a Roth IRA, 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 are 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 are 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 has not been reduced by the exclusion amount. See the instructions for Form 1040, 1040A, or 1040NR 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 is 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 are 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 (Form 1040)). 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 will receive payments next year that are not 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 is your basis in a designated Roth account; the part of premiums paid on commercial annuities or insurance contracts recovered tax free; or the nontaxable part of a charitable gift annuity. This box does not 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 Roth IRA, see the instructions for Box 2a. If the distribution was a direct rollover, the NUA is included in box 2a. If you did not receive a lump-sum distribution, the amount shown is the NUA attributable to employee contributions, which is not 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 2016. 9—Cost of current life insurance protection. A—May be eligible for 10-year tax option (see Form 4972). B—Designated Roth account distribution. (Continued on the back of Copy 2.) CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code OMB No. 1545-0119 1 Gross distribution 2a Taxable amount 2016 $ Form $ 2b Taxable amount not determined PAYER’S federal identification number RECIPIENT’S identification number Total distribution 3 Capital gain (included in box 2a) $ /Designated Roth contributions or insurance premiums $ 4 Federal income tax withheld 6 Net unrealized appreciation in employer’s securities $ 7 Distribution code(s) Street address (including apt. no.) Copy 2 File this copy with your state, city, or local income tax return, when required. $ 5 Employee contributions RECIPIENT’S name 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. IRA/ SEP/ SIMPLE 8 Other $ City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total distribution 10 Amount allocable to IRR within 5 years 11 1st year of desig. Roth contrib. FATCA filing requirement $ 12 State tax withheld $ $ Form 1099-R www.irs.gov/form1099r $ 13 State/Payer’s state no. 14 State distribution $ $ 15 Local tax withheld Account number (see instructions) % % 9b Total employee contributions $ $ 16 Name of locality 17 Local distribution $ $ Department of the Treasury - Internal Revenue Service Instructions for Recipient (Continued) Note: If Code B is in box 7 and an amount is reported in box 10, see the Instructions for Form 5329. D—Annuity payments from nonqualified annuities that may be subject to tax under section 1411. E—Distributions under Employee Plans Compliance Resolution System (EPCRS). 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. N—Recharacterized IRA contribution made for 2016 and recharacterized in 2016. P—Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2015. Q—Qualified distribution from a Roth IRA. R—Recharacterized IRA contribution made for 2015 and recharacterized in 2016. 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 is not 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 have 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 is not taxable when you receive it and should not be included in boxes 1 and 2a. When you receive periodic payments from the annuity contract, they are 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 will 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 1st year you made a contribution to the designated Roth account reported on this form is shown in this box. Boxes 12–17. If state or local income tax was withheld from the distribution, boxes 14 and 17 may show the part of the distribution subject to state and/or local tax. Future developments. For the latest information about developments related to Form 1099-R and its instructions, such as legislation enacted after they were published, go to www.irs.gov/form1099r. Additional information. You may want to see: Form W-4P Form 4972 Form 5329 Form 8606 Pub. 560 Pub. 571 Pub. 575 Pub. 590-A Pub. 590-B Pub. 721 Pub. 939 Pub. 969 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code OMB No. 1545-0119 1 Gross distribution 2a Taxable amount 2016 $ Form $ 2b Taxable amount not determined PAYER’S federal identification number RECIPIENT’S identification number Total distribution 3 Capital gain (included in box 2a) $ /Designated Roth contributions or insurance premiums $ For Payer 4 Federal income tax withheld 6 Net unrealized appreciation in employer’s securities For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. $ 7 Distribution code(s) Street address (including apt. no.) Copy D $ 5 Employee contributions RECIPIENT’S name 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. IRA/ SEP/ SIMPLE 8 Other $ City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total distribution 10 Amount allocable to IRR within 5 years 11 1st year of desig. Roth contrib. FATCA filing requirement $ 12 State tax withheld $ $ Form 1099-R www.irs.gov/form1099r $ 13 State/Payer’s state no. 14 State distribution $ $ 15 Local tax withheld Account number (see instructions) % % 9b Total employee contributions $ $ 16 Name of locality 17 Local distribution $ $ Department of the Treasury - Internal Revenue Service Instructions for Payer To complete Form 1099-R, use: • the 2016 General Instructions for Certain Information Returns, and • the 2016 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, 3922, or 5498 that you print from the IRS website. Due dates. Furnish Copies B, C, and 2 of this form to the recipient by January 31, 2017. File Copy A of this form with the IRS by February 28, 2017. If you file electronically, the due date is March 31, 2017. 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. Need help? If you have questions about reporting on Form 1099-R, 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-r.pdf, last modified December 2015

More about the Federal Form 1099-R Other TY 2016

We last updated the Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. in May 2017, so this is the latest version of Form 1099-R, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 1099-R directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

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-R from the Internal Revenue Service in May 2017.

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Historical Past-Year Versions of Federal Form 1099-R

We have a total of six past-year versions of Form 1099-R in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 1099-R

2016 Form 1099-R

Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2015 Form 1099-R

2016 Form 1099-R

Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2014 Form 1099-R

2015 Form 1099-R

Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2013 Form 1099-R

2013 Form 1099-R

Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2012 Form 1099-R

2012 Form 1099-R

Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2011 Form 1099-R

2012 Form 1099-R


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