WRN for Form 3922

Tax Forms & Publications

Work Request Notification
Title: Form 3922, Transfer of Stock Acquired Through an Employee Stock Purchase Plan Under Section 423(c)
Tax Year: 2009

Processing Year: 2010

Route to:

Approved:

Section Chief:

Ellen Fingerman

Date:

Ellen
Fingerman

Digitally signed by 62PDB
DN: cn=62PDB, email=Ellen.A.Fingerman@irs.gov
Date: 2008.08.21 16:12:18 -04'00'

Reviewer:

Mark Richter

S80BB

Review Chief:

Marilyn Ward

Marilyn Ward

08/21/08

Digitally signed by S80BB
DN: cn=S80BB, email=Mark.E.Richter@irs.gov
Date: 2008.08.21 16:19:20 -04'00'

I have reviewed this document
2008.08.21 16:51:20 -04'00'

Branch Chief:
Digitally signed by B50DB
DN: cn=B50DB, email=Robert.A.Erickson@irs.gov
Date: 2008.08.22 13:18:00 -04'00'

Senior Technical Advisor: Bob Erickson
Initiator (Tax Law Specialist):

GH1LB

Digitally signed by GH1LB
DN: cn=GH1LB, email=Melody.G.Devoe@irs.
gov
Date: 2008.08.22 13:23:52 -04'00'

08/22/08

The information in this document can be used to develop any necessary Work Requests.
This notification is for changes due to:
✔ Legislation or Chief Counsel guidance:

A Program change initiated by:
The major changes are as follows:
This is a major revision of a form last used in 1978. The revision is made to reflect proposed regulations 1.6039-1(b), to be made
final by October 2008, which require corporations, which record a transfer of the legal title of a share of stock acquired by the
employee where the stock was acquired pursuant to the exercise of an option described in section 423(c), to file Form 3922 for
each transfer made during a particular year. Form 3922 is required to be filed for stock transfers occurring after 2008.
Information is to be reported as follows:
1. The name, address, and identifying number of the transferor.
2. The name, address, and employer identification number (EIN) of the corporation whose stock is being transferred.
3. The date the option was granted to the transferor (Box 1).
4. The date the option was exercised by the transferor (Box 2).
5. The fair market value of the stock on the date the option was granted (Box 3).
6. The fair market value of the stock on the date the option was exercised by the transferor (Box 4).
7. The exercise price per share (Box 5).
8. The number of shares to which legal title was transferred by the transferor (Box 6)
9. .The date the legal title of the share(s) was transferred by the transferor (Box 7).

✔ We may need to make further changes that would require a work request.

We do not anticipate the need for any further changes that would require a Work Request.
If you have any questions, please contact:
Name: Melody G. DeVoe

Name: Mark Richter

Title:

Title:

Tax Law Specialist

Tax Law Specialist (Reviewer)

Symbols: SE:W:CAR:MP:T:I:P

Symbols: SE:W:CAR:MP:T:I:R

Phone: 202-283-7635

Phone: 202-622-3105

Email: Melody.G.Devoe@irs.gov

Email: Mark.E.Richter@irs.gov

Room: C7-143 NCFB

Room: 6429 Main IR

Add "and" before
ZIP code and
remove "comma (,)
and telephone no."
after ZIP code

Increase font size
(Rev. December 2008)

2626

VOID

CORRECTED

CORPORATION’S name, street address, city, state, ZIP code, and telephone no.

1 Date option granted to
TRANSFEROR

OMB No. 1545-XXXX

Form 3922
2 Date option exercised
by TRANSFEROR

CORPORATION’S federal identification number TRANSFEROR’S identification number

Fair market
value
share
3 Exercise
price
perper
share
on grant date

TRANSFEROR’S name

(Rev. April 2008)

Transfer of Stock
Acquired Through
An Employee l.c./
Stock Purchase
Plan Under
Section 423(c)

share on
4 Fair
Fair market
Marketvalue
Valueper
(FMV)/share
exercise
datedate
on exercise

$

$

price per
share
5 Exercise
No. of shares
transferred

of of
shares
transferred
6 No.
Year
transfer

Copy A
For
Internal Revenue
Service Center
File with Form 1096.

Street address (including apt. no.)
7 Date title transferred by TRANSFEROR
City, state, and ZIP code

Account number (see instructions)

Form

3922

Do Not Cut or Separate Forms on This Page

(Rev. December 2008)/

Department of the Treasury - Internal Revenue Service

Cat. No. 41180P

—

Do Not Cut or Separate Forms on This Page

legal