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.
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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.
9292 |
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VOID |
CORRECTED |
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PAYER’S name, street address, city or town, state or province, country, ZIP |
Payer’s RTN (optional) |
OMB No. 1545-0112 |
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or foreign postal code, and telephone no. |
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Interest |
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2021 |
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Income |
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1 Interest income |
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$ |
Form 1099-INT |
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2 Early withdrawal penalty |
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Copy A |
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$ |
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PAYER’S TIN |
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RECIPIENT’S TIN |
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For |
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3 Interest on U.S. Savings Bonds and Treas. obligations |
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Internal Revenue |
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$ |
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Service Center |
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RECIPIENT’S name |
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4 Federal income tax withheld |
5 Investment expenses |
File with Form 1096. |
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$ |
$ |
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6 Foreign tax paid |
7 Foreign country or U.S. possession |
For Privacy Act |
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$ |
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Street address (including apt. no.) |
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and Paperwork |
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8 Tax-exempt interest |
9 Specified private activity bond |
Reduction Act |
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interest |
Notice, see the |
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City or town, state or province, country, and ZIP or foreign postal code |
$ |
$ |
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2021 General |
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Instructions for |
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10 Market discount |
11 Bond premium |
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Certain |
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$ |
$ |
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Information |
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FATCA filing |
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Returns. |
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requirement |
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12 Bond premium on Treasury obligations |
13 Bond premium on tax-exempt bond |
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$ |
$ |
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Account number (see instructions) |
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2nd TIN not. |
14 Tax-exempt and tax credit |
15 State |
16 State identification no. |
17 State tax withheld |
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bond CUSIP no. |
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$ |
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$ |
Form 1099-INT |
Cat. No. 14410K |
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www.irs.gov/Form1099INT |
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