Section 6050X- Reporting

Note: The draft you are looking for begins on the next page.

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0303

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country, ZIP or 1 Total amount required to be
paid
foreign postal code, and telephone no.

OMB No. 1545-2284
Form

$
2 Restitution/remediation
amount

1098-F

(Rev. December 2019)

Fines, Penalties, and
Other Amounts

For calendar year

20

$

DRAFT AS OF
August 13, 2019
DO NOT FILE
FILER’S TIN

PAYER’S TIN

3 Compliance amount

4 Date of order/agreement

$

For
Internal Revenue
Service Center

5 Jurisdiction

PAYER’S name

File with Form 1096.

6 Case number

Street address (including apt. no.)

7 Name or description of matter/suit/agreement

City or town, state or province, country, and ZIP or foreign postal code

8 Code

Form 1098-F (Rev. 12-2019)

Cat. No. 71382B

Do Not Cut or Separate Forms on This Page

www.irs.gov/Form1098F

—

Copy A

For Privacy Act and
Paperwork Reduction
Act Notice, see the
current General
Instructions for
Certain Information
Returns.

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP or 1 Total amount required to be
paid
foreign postal code, and telephone no.

OMB No. 1545-2284
Form

$
2 Restitution/remediation
amount

1098-F

(Rev. December 2019)

Fines, Penalties, and
Other Amounts

For calendar year

20

$

DRAFT AS OF
August 13, 2019
DO NOT FILE
FILER’S TIN

PAYER’S TIN

3 Compliance amount

4 Date of order/agreement

$

For Payer

5 Jurisdiction

PAYER’S name

Copy B

6 Case number

Street address (including apt. no.)

7 Name or description of matter/suit/agreement

City or town, state or province, country, and ZIP or foreign postal code

8 Code

Form 1098-F (Rev. 12-2019)

(keep for your records)

www.irs.gov/Form1098F

This is important tax
information and is
being furnished to
the IRS.

Department of the Treasury - Internal Revenue Service

Version A, Cycle 4
Dimensions: 7.3” x 3.5” Only RED copy is not fillable

Instructions for Payer
This statement has been furnished to you by a government or
governmental entity regarding a court order or an agreement with respect
to a violation or potential violation of law. Retain this statement for your
records.
Payer’s taxpayer identification number (TIN). For your protection, this
form may show only the last four digits of your TIN (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 TIN to the IRS.
Box 1. Shows the total amount required to be paid in relation to the violation or
potential violation of law as stated in a court order or an agreement.
Box 2. Shows the amount of restitution or remediation required to be paid
as stated in a court order or an agreement.
Box 3. Shows the amount identified in a court order or an agreement as
required to be paid for purposes of coming into compliance with any law.
Box 4. Shows the date the order was entered by the court or the
agreement was fully executed.
Box 5. Shows the name of the court, or any other entity, that entered the
order or approved the agreement, if applicable.

Box 6. Shows the case number associated with a court order or an
agreement, if applicable.
Box 7. Provides a name or description to identify the underlying case or
matter to which a court order or an agreement relates.
Box 8. Shows one or more of the following codes.
A—Multiple payments.
B—Multiple payers/defendants.
C—Multiple payees.
D—Property or services required to be acquired, constructed, or transferred
under a court order or an agreement.
E—Payment to third party at the direction of a government or governmental
entity.
F—Paid in full as of time of filing.
G—No payment received as of time of filing.
H—Deferred prosecution agreement.
Future developments. For the latest information about developments related
to Form 1098-F and its instructions, such as legislation enacted after they were
published, go to www.irs.gov/Form1098F.

DRAFT AS OF
August 13, 2019
DO NOT FILE

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country, ZIP or 1 Total amount required to be
foreign postal code, and telephone no.
paid

$
2 Restitution/remediation
amount

$

OMB No. 1545-2284
Form

1098-F

(Rev. December 2019)

Fines, Penalties, and
Other Amounts

For calendar year

20

DRAFT AS OF
August 13, 2019
DO NOT FILE
FILER’S TIN

3 Compliance amount

PAYER’S TIN

4 Date of order/agreement

$

For Filer

5 Jurisdiction

PAYER’S name

6 Case number

Street address (including apt. no.)

7 Name or description of matter/suit/agreement

City or town, state or province, country, and ZIP or foreign postal code

8 Code

Form 1098-F (Rev. 12-2019)

www.irs.gov/Form1098F

Copy C

For Privacy Act and
Paperwork Reduction
Act Notice, see the
current General
Instructions for
Certain Information
Returns.

Department of the Treasury - Internal Revenue Service

Instructions for Filer
To complete Form 1098-F, use:
• The current General Instructions for Certain
Information Returns, and
• The current Instructions for Form 1098-F.
To order these instructions and additional forms, go
to www.irs.gov/Form1098F.
Caution: Because paper forms are scanned during
processing, you cannot file Forms 1096, 1097, 1098,
1099, 3921, or 5498 that you download and print from
the IRS website.
Filing and furnishing. For filing and furnishing
instructions, including due dates, and to request filing
or furnishing extensions, see the current General
Instructions for Certain Information Returns.

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 for
Copy A.
Need help? If you have questions about reporting on
Form 1098-F, call the information reporting customer
service site toll free at 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).

DRAFT AS OF
August 13, 2019
DO NOT FILE