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

2021

Department of the Treasury
Internal Revenue Service

Instructions for Forms
1099-R and 5498

Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs,
Insurance Contracts, etc.
Section references are to the Internal Revenue Code unless
otherwise noted.

Future Developments

For the latest information about developments related to
Forms 1099-R and 5498 and their instructions, such as
legislation enacted after they were published, go to IRS.gov/
Form1099R or IRS.gov/Form5498.

What’s New
Form 1099-R
Safe harbor explanations for eligible rollover distributions. Notice 2020-62 contains the two model notices that
may be provided to recipients of eligible rollover distributions
to satisfy the notice requirements under section 402(f). See
Explanation to Recipients Before Eligible Rollover
Distributions (Section 402(f) Notice), later.

Reminders

Also, report on Form 1099-R death benefit payments
made by employers that are not made as part of a pension,
profit-sharing, or retirement plan. See Box 1, later.
Payments of reportable death benefits in accordance with
final regulations published under section 6050Y must be
reported on Form 1099-R.
Reportable disability payments made from a retirement
plan must be reported on Form 1099-R.
Generally, do not report payments subject to withholding
of social security and Medicare taxes on this form. Report
such payments on Form W-2, Wage and Tax Statement.
There is no special reporting for qualified charitable

TIP distributions under section 408(d)(8), qualified health

In addition, see the 2021 General Instructions for Certain
Information Returns for information on the following topics.
• Who must file (certain Foreign Financial Institutions (FFIs)
and U.S. payers that report on Form(s) 1099 to satisfy their
Internal Revenue Code chapter 4 reporting requirements).
• When and where to file.
• Electronic reporting.
• Corrected and void returns.
• Statements to recipients.
• Taxpayer identification numbers (TINs).
• Backup withholding.
• Penalties.
• The definitions of terms applicable for chapter 4 purposes
that are referenced in these instructions.
• Other general topics.
You can get the general instructions from General
Instructions for Certain Information Returns at IRS.gov/
1099GeneralInstructions or go to IRS.gov/Form1099R or
IRS.gov/Form5498.
Online fillable forms. To ease statement furnishing
requirements, Copies B, C, D, 1, and 2 have been made
fillable online in a PDF format available at IRS.gov/
Form1099R and IRS.gov/Form5498. You can complete
these copies online for furnishing statements to recipients
and for retaining in your own files.

Specific Instructions for Form 1099-R

File Form 1099-R, Distributions From Pensions, Annuities,
Retirement or Profit-Sharing Plans, IRAs, Insurance
Contracts, etc., for each person to whom you have made a
designated distribution or are treated as having made a
distribution of $10 or more from profit-sharing or retirement
plans, any individual retirement arrangements (IRAs),
Jan 06, 2021

annuities, pensions, insurance contracts, survivor income
benefit plans, permanent and total disability payments under
life insurance contracts, charitable gift annuities, etc.

savings account (HSA) funding distributions
described in section 408(d)(9), or for the payment of qualified
health insurance premiums (including long-term care
insurance premiums) for retired public safety officers
described in section 402(l).
Reportable death benefits. Under section 6050Y and the
Regulations thereunder, a payer must report reportable
death benefits paid after December 31, 2018, in connection
with a life insurance contract transferred after December 31,
2018, in a reportable policy sale. Reportable death benefits
are amounts paid by reason of the death of the insured under
a life insurance contract that has been transferred in a
reportable policy sale. In general, a reportable policy sale is
the acquisition of an interest in a life insurance contract,
directly or indirectly, if the acquirer has no substantial family,
business, or financial relationship with the insured apart from
the acquirer's interest in such life insurance contract. The
payer of reportable death benefits must file a return that
includes certain information, including the name of the
reportable death benefits payment recipient, the date and
gross amount of each payment, and the payer's estimate of
the buyer's investment in the contract. Under Regulations
section 1.6050Y-4(e), however, a payer does not have to file
a return for reportable death benefits payments in certain
situations, including when the reportable death benefits
payments are made to certain foreign payees and when the
payer does not receive, and has no knowledge of any issuer
having received, a reportable policy sale payment statement.
Military retirement annuities. Report payments to military
retirees or payments of survivor benefit annuities on Form
1099-R. Report military retirement pay awarded as a property
settlement to a former spouse under the name and TIN of the
recipient, not that of the military retiree.

Cat. No. 27987M

another contract of endowment insurance that provides for
regular payments to begin no later than they would have
begun under the old contract, or for an annuity contract, or for
a qualified long-term care insurance contract; or (c) an
annuity contract for an annuity contract or for a qualified
long-term care insurance contract; or (d) a qualified
long-term care insurance contract for a qualified long-term
care insurance contract. A contract shall not fail to be treated
as an annuity contract or as a life insurance contract solely
because a qualified long-term care insurance contract is a
part of or a rider on such contract. However, the distribution
of other property or the cancellation of a contract loan at the
time of the exchange may be taxable and reportable on a
separate Form 1099-R.
These exchanges of contracts are generally reportable on
Form 1099-R. However, reporting on Form 1099-R is not
required if (a) the exchange occurs within the same
company; (b) the exchange is solely a contract for contract
exchange, as defined above, that does not result in a
designated distribution; and (c) the company maintains
adequate records of the policyholder's basis in the contracts.
For example, a life insurance contract issued by Company X
received in exchange solely for another life insurance
contract previously issued by Company X does not have to
be reported on Form 1099-R as long as the company
maintains the required records. See Rev. Proc. 92-26,
1992-1 C.B. 744, for certain exchanges for which reporting is
not required under section 6047(d). Also, see Rev. Rul.
2007-24, 2007-21 I.R.B. 1282, available at IRS.gov/irb/
2007-21_IRB#RR-2007-24, for certain transactions that do
not qualify as tax-free exchanges. For more information on
partial exchanges of annuity contracts, see Rev. Proc.
2011-38, 2011-30 I.R.B. 66, available at IRS.gov/irb/
2011-30_IRB#RP-2011-38.
Regulations under section 6050Y provide that a section
1035 exchange constitutes a reportable policy sale in limited
circumstances. Death benefits paid by reason of the death of
the insured under the life insurance contract issued in such
circumstances are reportable death benefits that must be
reported on Form 1099-R.
For more information on reporting taxable exchanges, see
Box 1, later.

Use Code 7 in box 7 for reporting military pensions or
survivor benefit annuities. Use Code 4 for reporting
CAUTION death benefits paid to a survivor beneficiary on a
separate Form 1099-R. Do not combine with any other
codes.

!

Governmental section 457(b) plans. Report on Form
1099-R, not Form W-2, income tax withholding and
distributions from a section 457(b) plan maintained by a state
or local government employer. Distributions from a
governmental section 457(b) plan to a participant or
beneficiary include all amounts that are paid from the plan.
For more information, see Notice 2003-20 on page 894 of
Internal Revenue Bulletin 2003-19, at IRS.gov/pub/irs-irbs/
irb03-19.pdf. Also, see Governmental section 457(b) plan
distributions, later, for information on distribution codes.
Nonqualified plans. Report any reportable distributions
from commercial annuities. Report distributions to employee
plan participants from section 409A nonqualified deferred
compensation plans and eligible nongovernmental section
457(b) plans on Form W-2, not on Form 1099-R; for
nonemployees, these payments are reportable on Form
1099-NEC. Report distributions to beneficiaries of deceased
plan participants on Form 1099-MISC. See the Instructions
for Forms 1099-MISC and 1099-NEC for more information.
Section 404(k) dividends. Distributions of section 404(k)
dividends from an employee stock ownership plan (ESOP),
including a tax credit ESOP, are reported on Form 1099-R.
Distributions other than section 404(k) dividends from the
plan must be reported on a separate Form 1099-R.
Section 404(k) dividends paid directly from the
corporation to participants or their beneficiaries are reported
on Form 1099-DIV. See Announcement 2008-56, 2008-26
I.R.B. 1192, available at IRS.gov/irb/
2008-26_IRB#ANN-2008-56.
Charitable gift annuities. If cash or capital gain property is
donated in exchange for a charitable gift annuity, report
distributions from the annuity on Form 1099-R. See
Charitable gift annuities, later.
Life insurance, annuity, and endowment contracts.
Report payments of matured or redeemed annuity,
endowment, and life insurance contracts. However, you do
not need to file Form 1099-R to report the surrender of a life
insurance contract if it is reasonable to believe that none of
the payment is includible in the income of the recipient. If you
are reporting the surrender of a life insurance contract, see
Code 7, later. See, however, Box 1, later, for FFIs reporting in
a manner similar to section 6047(d) for the purposes of
chapter 4 of the Internal Revenue Code.
Report premiums paid by a trustee or custodian for the
cost of current life or other insurance protection. Costs of
current life insurance protection are not subject to the 10%
additional tax under section 72(t). See Cost of current life
insurance protection, later.
Report charges or payments for a qualified long-term care
insurance contract against the cash value of an annuity
contract or the cash surrender value of a life insurance
contract, which is excludable from gross income under
section 72(e)(11). See Code W, later.
Section 1035 exchange. A tax-free section 1035
exchange is the exchange of (a) a life insurance contract for
another life insurance contract, or for an endowment or
annuity contract, or for a qualified long-term care insurance
contract; or (b) a contract of endowment insurance for

Prohibited transactions. If an IRA owner engages in a
prohibited transaction with respect to an IRA, the assets of
the IRA are treated as distributed on the first day of the tax
year in which the prohibited transaction occurs. IRAs that
hold non-marketable securities and/or closely held
investments, in which the IRA owner effectively controls the
underlying assets of such securities or investments, have a
greater potential for resulting in a prohibited transaction.
Enter Code 5 in box 7.

Designated Roth Account Contributions

An employer offering a section 401(k), 403(b), or
governmental section 457(b) plan may allow participants to
contribute all or a portion of the elective deferrals they are
otherwise eligible to make to a separate designated Roth
account established under the plan. Contributions made
under a section 401(k) plan must meet the requirements of
Regulations section 1.401(k)-1(f) (Regulations section
1.403(b)-3(c) for a section 403(b) plan). Under the terms of
the section 401(k) plan, section 403(b) plan, or governmental
section 457(b) plan, the designated Roth account must meet
the requirements of section 402A.

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Instructions for Forms 1099-R and 5498 (2021)

!

CAUTION

A separate Form 1099-R must be used to report the
total annual distribution from a designated Roth
account.

Roth IRA conversions. You must report a traditional, SEP,
or SIMPLE IRA distribution that you know is converted this
year to a Roth IRA in boxes 1 and 2a (checking box 2b
“Taxable amount not determined” unless otherwise directed
elsewhere in these instructions), even if the conversion is a
trustee-to-trustee transfer or is with the same trustee. Enter
Code 2 or 7 in box 7 depending on the participant's age.

Distributions allocable to an in-plan Roth rollover (IRR).
The distribution of an amount allocable to the taxable amount
of an IRR, made within the 5-year period beginning with the
first day of the participant’s tax year in which the rollover was
made, is treated as includible in gross income for purposes of
applying section 72(t) to the distribution. The total amount
allocable to such an IRR is reported in box 10. See the
instructions for Box 10, later. An IRR is a rollover within a
retirement plan to a designated Roth account in the same
plan. See Notice 2010-84, 2010-51 I.R.B. 872, available at
IRS.gov/irb/2010-51_IRB#NOT-2010-84, as modified by
Notice 2013-74, 2013-52 I.R.B. 819, available at IRS.gov/irb/
2013-52_IRB#NOT-2013-74.

IRA escheatment. Payments made from IRAs to state
unclaimed property funds must be reported on Form 1099-R.
See Rev. Rul. 2020-24, 2020-45 I.R.B. 965, available at
IRS.gov/irb/2020-45_IRB#REV-RUL-2020-24; and Rev. Rul.
2018-17, 2018-25 I.R.B. 753, available at IRS.gov/irb/
2018-25_IRB#RR-2018-17, as modified by Notice 2018-90,
2018-49 I.R.B. 826, available at https://www.irs.gov/irb/
2018-49_IRB#NOT-2018-90.

IRA Revocation or Account Closure

IRA Distributions

If a traditional or Roth IRA is revoked during its first 7 days
(under Regulations section 1.408-6(d)(4)(ii)) or is closed at
any time by the IRA trustee or custodian due to a failure of
the taxpayer to satisfy the Customer Identification Program
requirements described in section 326 of the USA PATRIOT
Act, the distribution from the IRA must be reported. In
addition, Form 5498, IRA Contribution Information, must be
filed to report any regular, rollover, Roth IRA conversion, SEP
IRA, or SIMPLE IRA contribution to an IRA that is
subsequently revoked or closed by the trustee or custodian.

For deemed IRAs under section 408(q), use the rules
TIP that apply to traditional IRAs or Roth IRAs, as
applicable. Simplified employee pension (SEP) IRAs
and savings incentive match plan for employees (SIMPLE)
IRAs, however, may not be used as deemed IRAs.
Deemed IRAs. For more information on deemed IRAs in
qualified employer plans, see Regulations section
1.408(q)-1.

If a regular contribution is made to a traditional or Roth IRA
that later is revoked or closed, and a distribution is made to
the taxpayer, enter the gross distribution in
box 1. If no earnings are distributed, enter 0 (zero) in box 2a
and Code 8 in box 7 for a traditional IRA and Code J for a
Roth IRA. If earnings are distributed, enter the amount of
earnings in box 2a. For a traditional IRA, enter Codes 1 and
8, if applicable, in box 7; for a Roth IRA, enter Codes J and 8,
if applicable. These earnings could be subject to the 10%
early distribution tax under section 72(t). If a rollover
contribution is made to a traditional or Roth IRA that later is
revoked or closed, and distribution is made to the taxpayer,
enter in boxes 1 and 2a of Form 1099-R the gross distribution
and the appropriate code in box 7 (Code J for a Roth IRA).
Follow this same procedure for a transfer from a traditional or
Roth IRA to another IRA of the same type that later is
revoked or closed. The distribution could be subject to the
10% early distribution tax under section 72(t).

IRAs other than Roth IRAs. Unless otherwise instructed,
distributions from any IRA that is not a Roth IRA must be
reported in boxes 1 and 2a. Check the “Taxable amount not
determined” box in box 2b. But see:
• Traditional, SEP, or SIMPLE IRA, later, for how to report
the withdrawal of IRA contributions under section 408(d)(4);
• Transfers, later, for information on trustee-to-trustee
transfers, including recharacterizations;
• Reporting a corrective distribution from an IRA under
section 408(d)(5), see Traditional, SEP, or SIMPLE IRA,
later;
• Reporting IRA revocations or account closures due to
Customer Identification Program failures, see IRA
Revocation or Account Closure, later; and
• Reporting a transfer from a SIMPLE IRA to a non-SIMPLE
IRA within the first 2 years of plan participation, see
Traditional, SEP, or SIMPLE IRA, later.
The direct rollover provisions beginning later do not apply
to distributions from any IRA. However, taxable distributions
from traditional IRAs and SEP IRAs may be rolled over into
an eligible retirement plan. See section 408(d)(3). SIMPLE
IRAs may also be rolled over into an eligible retirement plan,
but only after the first 2 years of plan participation.
An IRA includes all investments under one IRA plan or
account. File only one Form 1099-R for distributions from all
investments under one plan that are paid in 1 year to one
recipient, unless you must enter different codes in box 7. You
do not have to file a separate Form 1099-R for each
distribution under the plan.

If an IRA conversion contribution or a rollover from a
qualified plan is made to a Roth IRA that later is revoked or
closed, and a distribution is made to the taxpayer, enter the
gross distribution in box 1 of Form 1099-R. If no earnings are
distributed, enter 0 (zero) in box 2a and Code J in box 7. If
earnings are distributed, enter the amount of the earnings in
box 2a and Code J in box 7. These earnings could be subject
to the 10% early distribution tax under section 72(t).
If an employer SEP IRA or SIMPLE IRA plan contribution
is made and the SEP IRA or SIMPLE IRA is revoked by the
employee or is closed by the trustee or custodian, report the
distribution as fully taxable.

Roth IRAs. For distributions from a Roth IRA, report the
gross distribution in box 1 but generally leave box 2a blank.
Check the “Taxable amount not determined” box in box 2b.
Enter Code J, Q, or T, as appropriate, in box 7. Do not use
any other codes with Code Q or Code T. You may enter
Code 8 or P with Code J. For the withdrawal of excess
contributions, see Roth IRA, later. It is not necessary to mark
the IRA/SEP/SIMPLE checkbox.
Instructions for Forms 1099-R and 5498 (2021)

For more information on IRAs that have been revoked,
see Rev. Proc. 91-70, 1991-2 C.B. 899.

Deductible Voluntary Employee Contributions
(DVECs)
If you are reporting a total distribution from a plan that
includes a distribution of DVECs, you may file a separate

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section 402(c)(3)(C) and Regulations section 1.402(c)-2,
Q/A-9 and Plan Loan Offsets, later.
7. Section 404(k) dividends.
8. Cost of current life insurance protection.
9. Distributions to a payee other than the employee, the
employee's surviving spouse, a spouse or former spouse
who is an alternate payee under a QDRO, or a nonspouse
designated beneficiary.
10. Any hardship distribution.
11. A permissible withdrawal under section 414(w).
12. Prohibited allocations of securities in an S corporation
that are treated as deemed distributions.
13. Distributions of premiums for accident or health
insurance under Regulations section 1.402(a)-1(e).

Form 1099-R to report the distribution of DVECs. If you do,
report the distribution of DVECs in boxes 1 and 2a on the
separate Form 1099-R. For the direct rollover (explained
later) of funds that include DVECs, a separate Form 1099-R
is not required to report the direct rollover of the DVECs.

Direct Rollovers

You must report a direct rollover of an eligible rollover
distribution. A direct rollover is the direct payment of the
distribution from a qualified plan, a section 403(b) plan, or a
governmental section 457(b) plan to a traditional IRA, Roth
IRA, or other eligible retirement plan. For additional rules
regarding the treatment of direct rollovers from designated
Roth accounts, see Designated Roth accounts, later. A direct
rollover may be made for the employee, for the employee's
surviving spouse, for the spouse or former spouse who is an
alternate payee under a qualified domestic relations order
(QDRO) or for a nonspouse designated beneficiary, in which
case the direct rollover can only be made to an inherited IRA.
If the distribution is paid to the surviving spouse, the
distribution is treated in the same manner as if the spouse
were the employee. See Part V of Notice 2007-7, 2007-5
I.R.B. 395, available at IRS.gov/irb/
2007-05_IRB#NOT-2007-7, which has been modified by
Notice 2009-82, 2009-41 I.R.B. 491, available at IRS.gov/irb/
2009-41_IRB#NOT-2009-82, and Notice 2020-51, 2020-29
I.R.B. 73, available at IRS.gov/irb/
2020-29_IRB#NOT-2020-51, for guidance on direct rollovers
by nonspouse designated beneficiaries. Also, see Notice
2008-30, Part II, 2008-12 I.R.B. 638, available at IRS.gov/irb/
2008-12_IRB#NOT-2008-30, which has been amplified and
clarified by Notice 2009-75, 2009-39 I.R.B. 436, available at
IRS.gov/irb/2009-39_IRB#NOT-2009-75, for questions and
answers covering rollover contributions to Roth IRAs.

Amounts paid under an annuity contract purchased for
and distributed to a participant under a qualified plan can
qualify as eligible rollover distributions. See Regulations
section 1.402(c)-2, Q/A-10.
Automatic rollovers. Eligible rollover distributions may also
include involuntary distributions that are more than $1,000
but not more than $5,000 and are made from a qualified plan
to an IRA on behalf of a plan participant. Involuntary
distributions are generally subject to the automatic rollover
provisions of section 401(a)(31)(B) and must be paid in a
direct rollover to an IRA, unless the plan participant elects to
have the rollover made to another eligible retirement plan or
to receive the distribution directly.
For information on the notification requirements, see
Explanation to Recipients Before Eligible Rollover
Distributions (Section 402(f) Notice), later. For additional
information, also see Notice 2005-5, 2005-3 I.R.B. 337,
available at IRS.gov/irb/2005-03_IRB#NOT-2005-5, as
modified by Notice 2005-95, 2005-51 I.R.B. 1172, available
at IRS.gov/irb/2005-51_IRB#NOT-2005-95.

An eligible rollover distribution is any distribution of all or
any portion of the balance to the credit of the employee
(including net unrealized appreciation (NUA)) from a qualified
plan, a section 403(b) plan, or a governmental section 457(b)
plan except the following.
1. One of a series of substantially equal periodic
payments made at least annually over:
a. The life of the employee or the joint lives of the
employee and the employee's designated beneficiary,
b. The life expectancy of the employee or the joint life
and last survivor expectancy of the employee and the
employee's designated beneficiary, or
c. A specified period of 10 years or more.
2. A required minimum distribution (RMD) under section
401(a)(9). A plan administrator is permitted to assume there
is no designated beneficiary for purposes of determining the
minimum distribution.
3. Elective deferrals (under section 402(g)(3)) and
employee contributions (including earnings on each)
returned because of the section 415 limits.
4. Corrective distributions of excess deferrals (under
section 402(g)) and earnings.
5. Corrective distributions of excess contributions under
a qualified cash or deferred arrangement (under section
401(k)) and excess aggregate contributions (under section
401(m)) and earnings.
6. Loans treated as deemed distributions (under section
72(p)). However, qualified plan loan offset amounts and plan
loan offset amounts can be eligible rollover distributions. See

Reporting a direct rollover. Report a direct rollover in
box 1 and a 0 (zero) in box 2a, unless the rollover is a direct
rollover of a qualified rollover contribution other than from a
designated Roth account. See Qualified rollover
contributions as defined in section 408A(e), later. You do not
have to report capital gain in box 3 or NUA in box 6. Enter
Code G in box 7 unless the rollover is a direct rollover from a
designated Roth account to a Roth IRA. See Designated
Roth accounts, later. If the direct rollover is made by a
nonspouse designated beneficiary, also enter Code 4 in
box 7.
Prepare the form using the name and social security
number (SSN) of the person for whose benefit the funds
were rolled over (generally, the participant), not those of the
trustee of the traditional IRA or other plan to which the funds
were rolled.
If part of the distribution is a direct rollover and part is
distributed to the recipient, prepare two Forms 1099-R.
For guidance on allocation of after-tax amounts to
rollovers, see Notice 2014-54, 2014-41 I.R.B. 670, available
at IRS.gov/irb/2014-41_IRB#NOT-2014-54.
For more information on eligible rollover distributions,
including substantially equal periodic payments, RMDs, and
plan loan offset amounts, see Regulations sections
1.402(c)-2 and 1.403(b)-7(b). See Rev. Rul. 2014-9, 2014-17
I.R.B. 975, available at IRS.gov/irb/
2014-17_IRB#RR-2014-9, for information on rollovers to
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Instructions for Forms 1099-R and 5498 (2021)

• A rollover contribution to a Roth IRA from another IRA that
meets the requirements of section 408(d)(3), or
• A rollover contribution to a Roth IRA from an eligible
retirement plan (other than an IRA) that meets the
requirements of section 408A(e)(1)(B).
For reporting a rollover from an IRA other than a Roth IRA
to a Roth IRA, see Roth IRA conversions, earlier and later.
For a direct rollover of an eligible rollover distribution to a
Roth IRA (other than from a designated Roth account), report
the total amount rolled over in box 1, the taxable amount in
box 2a, and any basis recovery amount in box 5. (See the
instructions for Box 5, later.) Use Code G in box 7. If the
direct rollover is made on behalf of a nonspouse designated
beneficiary, also enter Code 4 in box 7.
For reporting instructions for a direct rollover from a
designated Roth account, see Designated Roth accounts,
earlier.

qualified plans. Also, see Rev. Rul. 2002-62, which is on
page 710 of Internal Revenue Bulletin 2002-42 at
IRS.gov/pub/irs-irbs/irb02-42.pdf, for guidance on
substantially equal periodic payments.
For information on distributions of amounts

TIP attributable to rollover contributions separately

accounted for by an eligible retirement plan and if
permissible timing restrictions apply, see Rev. Rul. 2004-12,
2004-7 I.R.B. 478, available at IRS.gov/irb/
2004-07_IRB#RR-2004-12, as modified by Notice 2013-74,
2013-52 I.R.B. 819, available at IRS.gov/irb/
2013-52_IRB#NOT-2013-74.
Designated Roth accounts. A direct rollover from a
designated Roth account may only be made to another
designated Roth account or to a Roth IRA. A distribution from
a Roth IRA, however, cannot be rolled over into a designated
Roth account. In addition, a plan is permitted to treat the
balance of the participant's designated Roth account and the
participant's other accounts under the plan as accounts held
under two separate plans for purposes of applying the
automatic rollover rules of section 401(a)(31)(B) and Q/A-9
through Q/A-11 of Regulations section 1.401(a)(31)-1. Thus,
if a participant's balance in the designated Roth account is
less than $200, the plan is not required to offer a direct
rollover election or to apply the automatic rollover provisions
to such balance.
A distribution from a designated Roth account that is a
qualified distribution is tax free. A qualified distribution is a
payment that is made both after age 591/2 (or after death or
disabililty) and after the 5-tax-year period that begins with the
first day of the first tax year in which the employee makes a
contribution to the designated Roth account. Certain
amounts, including corrective distributions, cannot be
qualified distributions. See Regulations section 1.402A-1.
If any portion of a distribution from a designated Roth
account that is not includible in gross income is to be rolled
over into a designated Roth account under another plan, the
rollover must be accomplished by a direct rollover. Any
portion not includible in gross income that is distributed to the
employee, however, cannot be rolled over to another
designated Roth account, though it can be rolled over into a
Roth IRA within the 60-day period described in section
402(c)(3). In the case of a direct rollover, the distributing plan
is required to report to the recipient plan the amount of the
investment (basis) in the contract and the first year of the
5-tax-year period, or that the distribution is a qualified
distribution.
For a direct rollover of a distribution from a designated
Roth account to a Roth IRA, enter the amount rolled over in
box 1 and 0 (zero) in box 2a. Use Code H in box 7. For all
other distributions from a designated Roth account, use
Code B in box 7, unless Code E applies. If the direct rollover
is from one designated Roth account to another designated
Roth account, also enter Code G in box 7.
For a direct rollover of a distribution from a section 401(k)
plan, a section 403(b) plan, or a governmental section 457(b)
plan to a designated Roth account in the same plan, enter
the amount rolled over in box 1, the taxable amount in
box 2a, and any basis recovery amount in box 5. Use Code
G in box 7.
Qualified rollover contributions as defined in section
408A(e). A qualified rollover contribution as defined in
section 408A(e) is:

Instructions for Forms 1099-R and 5498 (2021)

Explanation to Recipients Before Eligible
Rollover Distributions (Section 402(f) Notice)

For qualified plans, section 403(b) plans, and governmental
section 457(b) plans, the plan administrator must provide to
each recipient of an eligible rollover distribution an
explanation using either a written paper document or an
electronic medium (section 402(f) notice). The explanation
must be provided no more than 180 days and no fewer than
30 days before making an eligible rollover distribution or
before the annuity starting date. However, if the recipient who
has received the section 402(f) notice affirmatively elects a
distribution, you will not fail to satisfy the timing requirements
merely because you make the distribution fewer than 30 days
after you provided the notice as long as you meet the
requirements of Regulations section 1.402(f)-1, Q/A-2. The
electronic section 402(f) notice must meet the requirements
for using electronic media in Regulations section
1.401(a)-21.
The notice must explain the rollover rules, the special tax
treatment for certain lump-sum distributions, the direct
rollover option (and any default procedures), the mandatory
20% withholding rules, and an explanation of how
distributions from the plan to which the rollover is made may
have different restrictions and tax consequences than the
plan from which the rollover is made.
For periodic payments that are eligible rollover
distributions, you must provide the notice before the first
payment and at least once a year as long as the payments
continue. For section 403(b) plans, the payer must provide
an explanation of the direct rollover option within the time
period described earlier or some other reasonable period of
time.
Notice 2020-62, 2020-35 I.R.B. 476 available at
IRS.gov/irb/2020-35_IRB#NOT-2020-62, contains two safe
harbor explanations that may be provided to recipients of
eligible rollover distributions from an employer plan in order
to satisfy section 402(f).
Involuntary distributions. For involuntary distributions paid
to an IRA in a direct rollover (automatic rollover), you may
satisfy the notification requirements of section 401(a)(31)(B)
(i) either separately or as a part of the section 402(f) notice.
The notification must be in writing and may be sent using
electronic media in accordance with Q/A-5 of Regulations
section 1.402(f)-1. Also, see Notice 2005-5, Q/A-15.
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Transfers

408(d)(6), is tax free. Do not report such a transfer on Form
1099-R.

Generally, do not report a transfer between trustees or
issuers that involves no payment or distribution of funds to
the participant, including a trustee-to-trustee transfer from
one IRA to another IRA, valid transfers from one section
403(b) plan in accordance with paragraphs 1 through 3 of
Regulations section 1.403(b)-10(b), or for the purchase of
permissive service credit under section 403(b)(13) or section
457(e)(17) in accordance with paragraph 4 of Regulations
section 1.403(b)-10(b) and Regulations section 1.457-10(b)
(8). However, you must report:
• Recharacterized IRA contributions;
• Roth IRA conversions;
• Direct rollovers from qualified plans, section 403(b) plans,
or governmental section 457(b) plans, including any direct
rollovers from such plans that are IRRs or are qualified
rollover contributions described in section 408A(e); and
• Direct payments from IRAs to accepting employer plans.

Corrective Distributions

You must report on Form 1099-R corrective distributions of
excess deferrals, excess contributions and excess aggregate
contributions under section 401(a) plans, section 401(k) cash
or deferred arrangements, section 403(a) annuity plans,
section 403(b) salary reduction agreements, and salary
reduction simplified employee pensions (SARSEPs) under
section 408(k)(6). Excess contributions that are
recharacterized under a section 401(k) plan are treated as
distributed. Corrective distributions must include earnings
through the end of the year in which the excess arose. These
distributions are reportable on Form 1099-R and are
generally taxable in the year of the distribution (except for
excess deferrals under section 402(g)). Enter Code 8 or P in
box 7 (with Code B, if applicable) to designate the distribution
and the year it is taxable.

IRA recharacterizations. You must report each
recharacterization of an IRA contribution. If a participant
makes a contribution to an IRA (first IRA) for a year, the
participant may choose to recharacterize the contribution by
transferring, in a trustee-to-trustee transfer, any part of the
contribution (plus earnings) to another IRA (second IRA). The
contribution is treated as made to the second IRA
(recharacterization). A recharacterization may be made with
the same trustee or with another trustee. The trustee of the
first IRA must report the recharacterization as a distribution
on Form 1099-R and the contribution to the first IRA and its
character on Form 5498.
Enter the fair market value (FMV) of the amount
recharacterized in box 1, 0 (zero) in box 2a, and Code R in
box 7 if reporting a recharacterization of a prior-year (2020)
contribution or Code N if reporting a recharacterization of a
contribution in the same year (2021). It is not necessary to
check the IRA/SEP/SIMPLE checkbox. For more information
on how to report, see Notice 2000-30 on page 1266 of
Internal Revenue Bulletin 2000-25 at IRS.gov/pub/irs-irbs/
irb00-25.pdf.

Use a separate Form 1099-R to report a corrective
distribution from a designated Roth account.
The total amount of the elective deferral is reported in

TIP box 12 of Form W-2. See the Instructions for Forms
W-2 and W-3 for more information.

For more information about reporting corrective
distributions, see Table 1 ; Notice 89-32, 1989-1 C.B. 671;
Notice 88-33, 1988-1 C.B. 513; Notice 87-77, 1987-2 C.B.
385; and the Regulations under sections 401(k), 401(m),
402(g), and 457.
Excess deferrals. Excess deferrals under section 402(g)
can occur in section 401(k) plans, section 403(b) plans, or
SARSEPs. If distributed by April 15 of the year following the
year of deferral, the excess is taxable to the participant in the
year of deferral (other than designated Roth contributions),
but the earnings are taxable in the year distributed. Except
for a SARSEP, if the distribution occurs after April 15, the
excess is taxable in the year of deferral and the year
distributed. The earnings are taxable in the year distributed.
For a SARSEP, excess deferrals not withdrawn by April 15
are considered regular IRA contributions subject to the IRA
contribution limits. Corrective distributions of excess
deferrals are not subject to federal income tax withholding or
social security and Medicare taxes. For losses on excess
deferrals, see Losses, later. See Regulations section
1.457-4(e) for special rules relating to excess deferrals under
governmental section 457(b) plans.

No recharacterizations of conversions made in 2018 or
later. A conversion of a traditional IRA to a Roth IRA, and a
rollover from any other eligible retirement plan to a Roth IRA,
made in the participant’s tax years beginning after December
31, 2017, cannot be recharacterized as having been made to
a traditional IRA.
Section 1035 exchange. You may have to report
exchanges of insurance contracts, including an exchange
under section 1035, under which any designated distribution
may be made. For a section 1035 exchange that is in part
taxable, file a separate Form 1099-R to report the taxable
amount. See Section 1035 exchange, earlier.

Excess contributions. Excess contributions can occur in a
section 401(k) plan or a SARSEP. All distributions of the
excess contributions plus earnings (other than designated
Roth contributions), including recharacterized excess
contributions, are taxable to the participant in the year of
distribution. Report the gross distribution in box 1 of Form
1099-R. In box 2a, enter the excess contribution and
earnings distributed less any designated Roth contributions.
For a SARSEP, the employer must notify the participant by
March 15 of the year after the year the excess contribution
was made that the participant must withdraw the excess and
earnings. All distributions from a SARSEP are taxable in the
year of distribution. An excess contribution not withdrawn by
April 15 of the year after the year of notification is considered
a regular IRA contribution subject to the IRA contribution
limits.

SIMPLE IRAs. Do not report a trustee-to-trustee transfer
from one SIMPLE IRA to another SIMPLE IRA. However, you
must report as a taxable distribution in boxes 1 and 2a a
trustee-to-trustee transfer from a SIMPLE IRA to an IRA that
is not a SIMPLE IRA during the 2-year period beginning on
the day contributions are first deposited in the individual's
SIMPLE IRA by the employer. Use Code S in box 7, if
appropriate.
Transfer of an IRA to spouse. If you transfer or
re-designate an interest from one spouse's IRA to an IRA for
the other spouse under a divorce or separation instrument,
the transfer or re-designation, as provided under section
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Instructions for Forms 1099-R and 5498 (2021)

!

or SIMPLE IRA plans are returned to an employer (with the
participant's consent), enter the gross distribution (excess
and earnings) in box 1 and 0 (zero) in box 2a. Enter Code E
in box 7.

Regulations have not been updated for SARSEPs.

CAUTION

Excess aggregate contributions. Excess aggregate
contributions under section 401(m) can occur in section
401(a), section 401(k), section 403(a), and section 403(b)
plans. A corrective distribution of excess aggregate
contributions plus earnings is taxable to the participant in the
year the distribution was made. Report the gross distribution
in box 1 of Form 1099-R. In box 2a, enter the excess and
earnings distributed less any after-tax contributions.

Failing the ADP or ACP Test After a Total
Distribution

If you make a total distribution in 2021 and file a Form 1099-R
with the IRS and then discover in 2022 that the plan failed
either the section 401(k)(3) actual deferral percentage (ADP)
test for 2021 and you compute excess contributions or the
section 401(m)(2) actual contribution percentage (ACP) test
and you compute excess aggregate contributions, you must
recharacterize part of the total distribution as excess
contributions or excess aggregate contributions. First, file a
CORRECTED Form 1099-R for 2021 for the correct amount
of the total distribution (not including the amount
recharacterized as excess contributions or excess aggregate
contributions). Second, file a new Form 1099-R for 2021 for
the excess contributions or excess aggregate contributions
and allocable earnings.

Losses. If a corrective distribution of an excess deferral is
made in a year after the year of deferral and a net loss has
been allocated to the excess deferral, report the corrective
distribution amount in boxes 1 and 2a of Form 1099-R for the
year of the distribution with the appropriate distribution code
in box 7. If the excess deferrals consist of designated Roth
contributions, report the corrective distribution amount in
box 1, 0 (zero) in box 2a, and the appropriate distribution
code in box 7. However, taxpayers must include the total
amount of the excess deferral (unadjusted for loss) in income
in the year of deferral, and they may report a loss on the tax
return for the year the corrective distribution is made.

To avoid a late filing penalty if the new Form 1099-R is
filed after the due date, enter in the bottom margin of Form
1096, Annual Summary and Transmittal of U.S. Information
Returns, the words “Filed To Correct Excess Contributions.”

Distributions Under Employee Plans
Compliance Resolution System (EPCRS)

You must also issue copies of the Forms 1099-R to the
plan participant with an explanation of why these new forms
are being issued. ADP and ACP test corrective distributions
are exempt from the 10% early distribution tax under section
72(t).

The procedure for correcting excess annual additions under
section 415 is explained in the latest EPCRS revenue
procedure in section 6.06 of Rev. Proc. 2019-19, 2019-19
I.R.B. 1086, available at IRS.gov/irb/2019-19_IRB#REVPROC-2019-19.

Loans Treated as Distributions

Distributions to correct a section 415 failure are not
eligible rollover distributions although they are subject to
federal income tax withholding under section 3405. They are
not subject to social security, Medicare, or Federal
Unemployment Tax Act (FUTA) taxes. In addition, such
distributions are not subject to the 10% early distribution tax
under section 72(t).

A loan from a qualified plan under section 401(a) or 403(a),
from a section 403(b) plan, or from a plan, whether or not
qualified, that is maintained by the United States, a state or
political subdivision thereof, or any agency or instrumentality
thereof, made to a participant or beneficiary is not treated as
a distribution from the plan if the loan satisfies the following
requirements.
1. The loan is evidenced by an enforceable agreement.
2. The agreement specifies that the loan must be repaid
within 5 years, except for a principal residence.
3. The loan must be repaid in substantially level
installments (at least quarterly).
4. The loan amount does not exceed the limits in section
72(p)(2)(A) (maximum limit is equal to the lesser of 50% of
the vested account balance or $50,000).

You may report the distribution of elective deferrals (other
than designated Roth contributions) and employee
contributions (and earnings attributable to such elective
deferrals and employee contributions) on the same Form
1099-R. However, if you made other distributions during the
year, report them on a separate Form 1099-R. Because the
distribution of elective deferrals (other than designated Roth
contributions) is fully taxable in the year distributed (no part of
the distribution is a return of the investment in the contract),
report the total amount of the distribution in boxes 1 and 2a.
Leave box 5 blank, and enter Code E in box 7. For a return of
employee contributions (or designated Roth contributions)
plus earnings, enter the gross distribution in box 1, the
earnings attributable to the employee contributions (or
designated Roth contributions) being returned in box 2a, and
the employee contributions (or designated Roth
contributions) being returned in box 5. Enter Code E in box 7.
For more information, see Rev. Proc. 92-93, 1992-2 C.B.
505.

Certain exceptions, cure periods, and suspension of the
repayment schedule may apply.
The loan agreement must specify the amount of the loan,
the term of the loan, and the repayment schedule. The
agreement may include more than one document.
If a loan fails to satisfy (1), (2), or (3), the balance of the
loan is a deemed distribution. The distribution may occur at
the time the loan is made or later if the loan is not repaid in
accordance with the repayment schedule.

Similar rules apply to other corrective distributions under
EPCRS. Also, special Form 1099-R reporting is available for
certain plan loan failures. See section 6.07 of Rev. Proc.
2019-19 for details.

If a loan fails to satisfy (4) at the time the loan is made, the
amount that exceeds the amount permitted to be loaned is a
deemed distribution.
Deemed distribution. If a loan is treated as a deemed
distribution, it is reportable on Form 1099-R using the normal

If excess employer contributions (other than elective
deferrals), and the earnings on them, under SEP, SARSEP,
Instructions for Forms 1099-R and 5498 (2021)

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For example, if you transmit a direct rollover and file a Form
1099-R with the IRS reporting that none of the direct rollover
is taxable by entering 0 (zero) in box 2a, and you then
discover that part of the direct rollover consists of RMDs
under section 401(a)(9), you must file a corrected Form
1099-R reporting the eligible rollover distribution as the direct
rollover and file a new Form 1099-R reporting the RMD as if it
had been distributed to the participant. See part H in the
2021 General Instructions for Certain Information Returns, or
Pub. 1220, if filing electronically.

taxation rules of section 72, including tax basis rules. The
distribution may also be subject to the 10% early distribution
tax under section 72(t). It is not eligible to be rolled over to an
eligible retirement plan nor is it eligible for the 10-year tax
option. On Form 1099-R, complete the appropriate boxes,
including boxes 1 and 2a, and enter Code L in box 7. Also,
enter Code 1 or Code B, if applicable.
Interest that accrues after the deemed distribution of a
loan is not an additional loan, and, therefore, is not reportable
on Form 1099-R.
Loans that are treated as deemed distributions or that are
actual distributions are subject to federal income tax
withholding. If such a distribution occurs after the loan is
made, you must withhold only if you distributed cash or
property (other than employer securities) at the time of the
deemed or actual distribution. See section 72(p), section
72(e)(4)(A), and Regulations section 1.72(p)-1.

If you filed a Form 1099-R with the IRS reporting a
payment of reportable death benefits, you must file a
corrected return within 15 calendar days of recovering any
portion of the reportable death benefits from the reportable
death benefits payment recipient as a result of the rescission
of the reportable policy sale.
If you furnished a statement to the reportable death
benefits payment recipient, you must furnish the recipient
with a corrected statement within 15 calendar days of
recovering any portion of the reportable death benefits from
the reportable death benefits payment recipient as a result of
the rescission of the reportable policy sale.

Subsequent repayments. If a participant makes any cash
repayments on a loan that was reported on Form 1099-R as
a deemed distribution, the repayments increase the
participant's tax basis in the plan as if the repayments were
after-tax contributions. However, such repayments are not
treated as after-tax contributions for purposes of section
401(m) or 415(c)(2)(B).
For a deemed distribution that was reported on Form
1099-R but was not repaid, the deemed distribution does not
increase the participant's basis.

Filer

The payer, trustee, or plan administrator must file Form
1099-R using the same name and employer identification
number (EIN) used to deposit any tax withheld and to file
Form 945, Annual Return of Withheld Federal
Income Tax.

Plan loan offsets. If a participant's accrued benefit is
reduced (offset) to repay a loan, the amount of the account
balance that is offset against the loan is an actual distribution.
Report it as you would any other actual distribution. Do not
enter Code L in box 7.
A qualified plan loan offset is a type of plan loan offset that
meets certain requirements. In order to be a qualified plan
loan offset, the loan, at the time of the offset, must be a loan
in good standing and the offset must be solely by reason of
(1) the termination of the qualified employer plan, or (2) the
failure to meet the repayment terms because the employee
had a severance from employment. Report a qualified plan
loan offset as you would any other actual distribution. In
addition, enter Code M in box 7.

Beneficiaries

If you make a distribution to a beneficiary, trust, or estate,
prepare Form 1099-R using the name and TIN of the
beneficiary, trust, or estate, not that of the decedent. If there
are multiple beneficiaries, report on each Form 1099-R only
the amount paid to the beneficiary whose name appears on
the Form 1099-R, and enter the percentage in box 9a, if
applicable.

Disclaimers. A beneficiary may make a qualified disclaimer
of all or some of an IRA account balance if the disclaimed
amount and income are paid to a new beneficiary or
segregated in a separate account. A qualified disclaimer may
be made after the beneficiary has previously received the
RMD for the year of the decedent's death. For more
information, see Rev. Rul. 2005-36, 2005-26 I.R.B. 1368,
available at IRS.gov/irb/2005-26_IRB#RR-2005-36.

Permissible Withdrawals Under Section 414(w)

For permissible withdrawals from an eligible automatic
contribution arrangement (EACA) under section 414(w):
• The distribution (except to the extent the distribution
consists of designated Roth contributions) is included in the
employee's gross income in the year distributed;
• Report principal and earnings in boxes 1 and 2a except, in
the case of a distribution from a designated Roth account,
report only earnings in box 2a;
• The distribution is not subject to the 10% additional tax
under section 72(t), indicated by reporting Code 2 in box 7;
and
• The distribution must be elected by the employee no later
than 90 days after the first default elective contribution under
the EACA, as specified in Regulations section 1.414(w)-1(c)
(2).

Alternate Payee Under a QDRO

Distributions to an alternate payee who is a spouse or former
spouse of the employee under a QDRO are reportable on
Form 1099-R using the name and TIN of the alternate payee.
If the alternate payee under a QDRO is a nonspouse, enter
the name and TIN of the employee. However, this rule does
not apply to IRAs; see Transfer of an IRA to spouse, earlier.

Nonresident Aliens

If income tax is withheld under section 3405 on any
distribution to a nonresident alien, report the distribution and
withholding on Form 1099-R. Also, file Form 945 to report the
withholding. See the presumption rules in part S of the 2021
General Instructions for Certain
Information Returns.

If the distribution is from a designated Roth account, enter
Code B as well as Code 2 in box 7.

Corrected Form 1099-R

If you filed a Form 1099-R with the IRS and later discover that
there is an error on it, you must correct it as soon as possible.

However, any payments to a nonresident alien from any
trust under section 401(a); any annuity plan under section
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Instructions for Forms 1099-R and 5498 (2021)

in box 2a. Furnish a statement to the plan participant showing
the value of each bond at the time of distribution. This will
provide him or her with the information necessary to figure
the interest income on each bond when it is redeemed.

403(a); any annuity, custodial account, or retirement income
account under section 403(b); or any IRA account under
section 408(a) or (b) are subject to withholding under section
1441, unless there is an exception under a tax treaty. Report
the distribution and withholding on Form 1042, Annual
Withholding Tax Return for U.S. Source Income of Foreign
Persons, and Form 1042-S, Foreign Person's U.S. Source
Income Subject to Withholding.

Include in box 1 amounts distributed from a qualified
retirement plan for which the recipient elects to pay health
insurance premiums under a cafeteria plan or that are paid
directly to reimburse medical care expenses incurred by the
recipient (see Rev. Rul. 2003-62 on page 1034 of Internal
Revenue Bulletin 2003-25 at IRS.gov/pub/irs-irbs/
irb03-25.pdf). Also, include this amount in box 2a.

For guidance regarding covered expatriates, see Notice
2009-85, 2009-45 I.R.B. 598, available at IRS.gov/irb/
2009-45_IRB#NOT-2009-85.

Include in box 1 charges or payments for qualified
long-term care insurance contracts under combined
arrangements. Enter Code W in box 7.

Statements to Recipients

If you are required to file Form 1099-R, you must furnish a
statement to the recipient. For more information about the
requirement to furnish a statement to each recipient, see part
M in the 2021 General Instructions for Certain Information
Returns.

In addition to reporting distributions to beneficiaries of
deceased employees, report here any death benefit
payments made by employers that are not made as part of a
pension, profit-sharing, or retirement plan. Also, enter these
amounts in box 2a; enter Code 4 in box 7.

Truncating recipient's TIN on payee statements.
Pursuant to Regulations section 301.6109-4, all filers of Form
1099-R may truncate a recipient’s TIN (social security
number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or
employer identification number (EIN)) on payee statements.
Truncation is not allowed on any documents the filer files with
the IRS. A payer's TIN may not be truncated on any form.
See part J in the 2021 General Instructions for Certain
Information Returns for more information.

!

CAUTION

Include in box 1 the amount of any payment of reportable
death benefits.
For section 1035 exchanges that are reportable on Form
1099-R, enter the total value of the contract in box 1, 0 (zero)
in box 2a, the total premiums paid in box 5, and Code 6 in
box 7.

Do not enter a negative amount in any box on Form

TIP 1099-R.

Designated Roth account distributions. If you are making
a distribution from a designated Roth account, enter the
gross distribution in box 1, the taxable portion of the
distribution in box 2a, the basis included in the distributed
amount in box 5, any amount allocable to an IRR made within
the previous 5 years (unless an exception to section 72(t)
applies) in box 10, and the first year of the 5-tax-year period
for determining qualified distributions in box 11. Also, enter
the applicable code(s) in box 7.

Account Number

The account number is required if you have multiple
accounts for a recipient for whom you are filing more than
one Form 1099-R.
The account number is also required if you check the
“FATCA filing requirement” box. See Box 12, later.
Additionally, the IRS encourages you to designate an
account number for all Forms 1099-R that you file. See part L
in the 2021 General Instructions for Certain Information
Returns.

Employer securities and other property. If you distribute
employer securities or other property, include in box 1 the
FMV of the securities or other property on the date of
distribution. If there is a loss, see Losses, later.
If you are distributing worthless property only, you are not
required to file Form 1099-R. However, you may file and
enter 0 (zero) in boxes 1 and 2a and any after-tax employee
contributions or designated Roth contributions in box 5.

The policy number of the life insurance contract under
which benefits are paid is required if you are reporting a
payment of reportable death benefits.

Box 1. Gross Distribution

Charitable gift annuities. If cash or capital gain property is
donated in exchange for a charitable gift annuity, report the
total amount distributed during the year in box 1. See
Charitable gift annuities under Box 3, later.

Enter the total amount of the distribution before income tax or
other deductions were withheld. Include direct rollovers, IRA
direct payments to accepting employer plans,
recharacterized IRA contributions, Roth IRA conversions,
and premiums paid by a trustee or custodian for the cost of
current life or other insurance protection. Also, include in this
box distributions to plan participants from governmental
section 457(b) plans. However, in the case of a distribution
by a trust representing certificates of deposit (CDs)
redeemed early, report the net amount distributed. Also, see
Box 6, later.

FFIs reporting in a manner similar to section 6047(d). If
you are a participating FFI electing to report with respect to a
cash value insurance contract or annuity contract that is a
U.S. account held by a specified U.S. person in a manner
similar to section 6047(d), include in box 1 any amount paid
under the contract during the reporting period (that is, the
calendar year or the year ending on the most recent contract
anniversary date).

For a distribution from a traditional IRA of assets that do
not have a readily available FMV, enter Code K in box 7.
Include in this box the value of U.S. Savings Bonds
distributed from a plan. Enter the appropriate taxable amount
Instructions for Forms 1099-R and 5498 (2021)

Do not report accelerated death benefits on Form
1099-R. Report them on Form 1099-LTC, Long-Term
Care and Accelerated Death Benefits.

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Do not report the account balance or value (as of the
end of the reporting period) in box 1. Participating
CAUTION FFIs reporting in a manner similar to section 6047(d)
should check the Recent Developments section for Form
1099-R at IRS.gov/Form1099R before filing for 2021.

1099-R for each. For the cost of current life insurance
protection, enter Code 9 in box 7.

Box 2a. Taxable Amount

Designated Roth account. Generally, a distribution from a
designated Roth account that is not a qualified distribution is
taxable to the recipient under section 402 in the case of a
plan qualified under section 401(a), under section 403(b)(1)
in the case of a section 403(b) plan, and under section
457(a)(1)(A) in the case of a governmental section 457(b)
plan. For purposes of section 72, designated Roth
contributions are treated as employer contributions, as
described in section 72(f)(1) (that is, as includible in the
participant's gross income).
Examples. Participant A received a nonqualified
distribution of $5,000 from the participant's designated Roth
account. Immediately before the distribution, the participant's
account balance was $10,000, consisting of $9,400 of
designated Roth contributions and $600 of earnings. The
taxable amount of the $5,000 distribution is $300
($600/$10,000 x $5,000). The nontaxable portion of the
distribution is $4,700 ($9,400/$10,000 x $5,000). The issuer
would report on Form 1099-R:
• Box 1, $5,000 as the gross distribution;
• Box 2a, $300 as the taxable amount;
• Box 4, $60 ($300 x 20%) as the withholding on the
earnings portion of the distribution;
• Box 5, $4,700 as the designated Roth contribution basis
(nontaxable amount);
• Box 7, Code B; and
• The first year of the 5-tax-year period in box 11.
Using the same facts as in the example above, except that
the distribution was a direct rollover to a Roth IRA, the issuer
would report on Form 1099-R:
• Box 1, $5,000 as the gross distribution;
• Box 2a, 0 (zero) as the taxable amount;
• Box 4, no entry;
• Box 5, $4,700 as the designated Roth contribution basis
(nontaxable amount);
• Box 7, Code H; and
• The first year of the 5-tax-year period in box 11.

!

DVECs. Include DVEC distributions in this box. Also, see
Deductible Voluntary Employee Contributions (DVECs),
earlier.

When determining the taxable amount to be entered
in box 2a, do not reduce the taxable amount by any
CAUTION portion of the $3,000 exclusion for which the
participant may be eligible as a payment of qualified health
and long-term care insurance premiums for retired public
safety officers under section 402(l).

!

Generally, you must enter the taxable amount in box 2a.
However, if you are unable to reasonably obtain the data
needed to compute the taxable amount, leave this box blank.
Except as provided under Box 6, later, do not enter
excludable or tax-deferred amounts reportable in boxes 5, 6,
and 8. Enter 0 (zero) in box 2a for:
• A direct rollover (other than an IRR) from a qualified plan, a
section 403(b) plan, or a governmental section 457(b) plan to
another such plan or to a traditional IRA;
• A direct rollover from a designated Roth account to a Roth
IRA;
• A traditional, SEP, or SIMPLE IRA directly transferred to
an accepting employer plan;
• An IRA recharacterization;
• A nontaxable section 1035 exchange of life insurance,
annuity, endowment, or long-term care insurance contracts;
or
• A nontaxable charge or payment, for the purchase of a
qualified long-term care insurance contract, against the cash
value of an annuity contract or the cash surrender value of a
life insurance contract.
Annuity starting date in 1998 or later. If you made annuity
payments from a qualified plan under section 401(a), 403(a),
or 403(b) and the annuity starting date is in 1998 or later, you
must use the simplified method under section 72(d)(1) to
figure the taxable amount. Under this method, the expected
number of payments you use to figure the taxable amount
depends on whether the payments are based on the life of
one or more than one person. See Notice 98-2, 1998-1 C.B.
266, and Pub. 575, Pension and Annuity Income, to help you
figure the taxable amount to enter in box 2a.

Losses. If a distribution is a loss, do not enter a negative
amount in this box. For example, if an employee's 401(k)
account balance, consisting solely of stock, is distributed but
the value is less than the employee's remaining after-tax
contributions or designated Roth contributions, enter the
value of the stock in box 1, leave box 2a blank, and enter the
employee's contributions or designated Roth contributions in
box 5.
For a plan with no after-tax contributions or designated
Roth contributions, even though the value of the account may
have decreased, there is no loss for reporting purposes.
Therefore, if there are no employer securities distributed,
show the actual cash and/or FMV of property distributed in
boxes 1 and 2a, and make no entry in box 5. If only employer
securities are distributed, show the FMV of the securities in
boxes 1 and 2a and make no entry in box 5 or 6. If both
employer securities and cash or other property are
distributed, show the actual cash and/or FMV of the property
(including employer securities) distributed in box 1, the gross
less any NUA on employer securities in box 2a (except as
provided under Box 6, later), no entry in box 5, and any NUA
in box 6.

Annuity starting date after November 18, 1996, and before 1998. Under the simplified method for figuring the
taxable amount, the expected number of payments is based
only on the primary annuitant's age on the annuity starting
date. See Notice 98-2.
Annuity starting date before November 19, 1996. If you
properly used the rules in effect before November 19, 1996,
for annuities that started before that date, continue to report
using those rules. No changes are necessary.
Corrective distributions. Enter in box 2a the amount of
excess deferrals, excess contributions, or excess aggregate
contributions (other than employee contributions or
designated Roth contributions). See Corrective Distributions,
earlier.
Cost of current life insurance protection. Include current
life insurance protection costs (net premium costs) that were
reported in box 1. However, do not report these costs and a
distribution on the same Form 1099-R. Use a separate Form
-10-

Instructions for Forms 1099-R and 5498 (2021)

In addition, enter an “X” in this box if you are an FFI
reporting in box 1 to satisfy your chapter 4 reporting
requirement under the election described in Regulations
section 1.1471-4(d)(5)(i)(B).

Roth IRA. For a distribution from a Roth IRA, report the total
distribution in box 1 and leave box 2a blank except in the
case of an IRA revocation or account closure and a
recharacterization, earlier. Use Code J, Q, or T as
appropriate in box 7. Use Code 8 or P, if applicable, in box 7
with Code J. Do not combine Code Q or T with any other
codes.
However, for the distribution of excess Roth IRA
contributions, report the gross distribution in box 1 and only
the earnings in box 2a. Enter Code J and Code 8 or P in
box 7.

If you check this box, leave box 2a blank; but see
Traditional, SEP, or SIMPLE IRA, earlier. Except for IRAs,
make every effort to compute the taxable amount.

Box 2b. Total Distribution

Enter an “X” in this box only if the payment shown in box 1 is
a total distribution. A total distribution is one or more
distributions within 1 tax year in which the entire balance of
the account is distributed. If periodic or installment payments
are made, mark this box in the year the final payment is
made.

Roth IRA conversions. Report the total amount converted
from a traditional IRA, SEP IRA, or SIMPLE IRA to a Roth
IRA in box 2a. Check the “Taxable amount not determined”
box in box 2b. A conversion is considered a distribution and
must be reported even if it is with the same trustee and even
if the conversion is done by a trustee-to-trustee transfer.
When an individual retirement annuity described in section
408(b) is converted to a Roth IRA, the amount that is treated
as distributed is the FMV of the annuity contract on the date
the annuity contract is converted. This rule also applies when
a traditional IRA holds an annuity contract as an account
asset and the traditional IRA is converted to a Roth IRA.
Determining the FMV of an individual retirement annuity
issued by a company regularly engaged in the selling of
contracts depends on the timing of the conversion as
outlined in Q/A-14 of Regulations section 1.408A-4.
For a Roth IRA conversion, use Code 2 in box 7 if the
participant is under age 591/2 or Code 7 if the participant is at
least age 591/2. Also, check the IRA/SEP/SIMPLE box in
box 7.

Box 3. Capital Gain (Included in Box 2a)

If any amount is taxable as a capital gain, report it in
box 3.

Charitable gift annuities. Report in box 3 any amount from
a charitable gift annuity that is taxable as a capital gain.
Report in box 1 the total amount distributed during the year.
Report in box 2a the taxable amount. Advise the annuity
recipient of any amount in box 3 subject to the 28% rate gain
for collectibles and any unrecaptured section 1250 gain.
Report in box 5 any nontaxable amount. Enter Code F in
box 7. See Regulations section 1.1011-2(c), Example 8.
Special rule for participants born before January 2,
1936 (or their beneficiaries). For lump-sum distributions
from qualified plans only, enter the amount in box 2a eligible
for the capital gain election under section 1122(h)(3) of the
Tax Reform Act of 1986 and section 641(f)(3) of the
Economic Growth and Tax Relief Reconciliation Act of 2001.
Enter the full amount eligible for the capital gain election. You
should not complete this box for a direct rollover.
To compute the months of an employee's active
participation before 1974, count as 12 months any part of a
calendar year in which an employee actively participated
under the plan; for active participation after 1973, count as 1
month any part of a month in which the employee actively
participated under the plan. See the Example below.
Active participation begins with the first month in which an
employee became a participant under the plan and ends with
the earliest of:
• The month in which the employee received a lump-sum
distribution under the plan;
• For an employee, other than a self-employed person or
owner-employee, the month in which the employee
separates from service;
• The month in which the employee dies; or
• For a self-employed person or owner-employee, the first
month in which the employee becomes disabled within the
meaning of section 72(m)(7).

Traditional, SEP, or SIMPLE IRA. Generally, you are not
required to compute the taxable amount of a traditional, SEP,
or SIMPLE IRA nor designate whether any part of a
distribution is a return of basis attributable to nondeductible
contributions. Therefore, except as provided below or
elsewhere in these instructions, report the total amount
distributed from a traditional, SEP, or SIMPLE IRA in box 2a.
This will be the same amount reported in box 1. Check the
“Taxable amount not determined” box in box 2b.
• For a distribution by a trust representing CDs redeemed
early, report the net amount distributed. Do not include any
amount paid for IRA insurance protection in
this box.
• For a distribution of contributions plus earnings from an
IRA before the due date of the return under section 408(d)
(4), report the gross distribution in box 1, only the earnings in
box 2a, and enter Code 8 or P, whichever is applicable, in
box 7. Also, enter Code 1 or 4, if applicable.
• For a distribution of excess contributions without earnings
after the due date of the individual's return under section
408(d)(5), leave box 2a blank, and check the “Taxable
amount not determined” box in box 2b. Use Code 1 or 7 in
box 7 depending on the age of the participant.
• For an amount in a traditional IRA or a SEP IRA paid
directly to an accepting employer plan, or an amount in a
SIMPLE IRA paid directly to an accepting employer plan after
the first 2 years of plan participation, enter the gross amount
in box 1, 0 (zero) in box 2a, and Code G in box 7.

Box 2b. Taxable Amount Not Determined

Enter an “X” in this box if you are unable to reasonably obtain
the data needed to compute the taxable amount.

Instructions for Forms 1099-R and 5498 (2021)

-11-

recipient cannot claim exemption from the 20% withholding
but may ask to have additional amounts withheld on Form
W-4P, Withholding Certificate for Pension or Annuity
Payments. If the recipient is not asking that additional
amounts be withheld, Form W-4P is not required for an
eligible rollover distribution because 20% withholding is
mandatory.
Employer securities and plan loan offset amounts that are
part of an eligible rollover distribution must be included in the
amount multiplied by 20% (0.20). However, the actual
amount to be withheld cannot be more than the sum of the
cash and the FMV of property (excluding employer securities
and plan loan offset amounts). For example, if the only part of
an eligible rollover distribution that is not a direct rollover is
employer securities or a plan loan offset amount, no
withholding is required. However, unless otherwise exempt,
any cash that is paid in the distribution must be used to
satisfy the withholding on the employer securities or plan
loan offset amount.
Depending on the type of plan or arrangement, the payer
or, in some cases, the plan administrator is required to
withhold 20% of eligible rollover distributions from a qualified
plan's distributed annuity and on eligible rollover distributions
from a governmental section 457(b) plan. For additional
information, see section 3405(d) and Regulations sections
35.3405-1T, Q/A A-13, and 31.3405(c)-1, Q/A-4 and -5. For
governmental section 457(b) plans only, see Notice 2003-20,
on page 894 of Internal Revenue Bulletin 2003-19, at
IRS.gov/pub/irs-irbs/irb03-19.pdf.
Any NUA excludable from gross income under section
402(e)(4) is not included in the amount of any eligible rollover
distribution that is subject to 20% withholding.
You are not required to withhold 20% of an eligible rollover
distribution that, when aggregated with other eligible rollover
distributions made to one person during the year, is less than
$200.

Method for Computing Amount Eligible for
Capital Gain Election (See Box 3, earlier.)
Step 1. Total Taxable Amount
A. Total distribution
B. Less:
1. Current actuarial value of any annuity
2. Employee contributions or designated Roth
contributions (minus any amounts previously
distributed that were not includible in the
employee's gross income)
3. Net unrealized appreciation in the value of any
employer securities that was a part of the
lump-sum distribution

XXXXX
XXXX

XXXX
XXXX

C. Total of lines 1 through 3

XXXXX

D. Total taxable amount. Subtract line C from line
A.

XXXXX

Step 2. Capital Gain

Total taxable
amount
Line D

X

Months of active
participation before 1974
____________________
Total months of active
participation

= Capital gain

Box 4. Federal Income Tax Withheld

Enter any federal income tax withheld. This withholding
under section 3405 is subject to deposit rules and the
withholding tax return is Form 945. Backup withholding does
not apply. See Pub. 15-A, Employer's Supplemental Tax
Guide, and the Instructions for Form 945 for more
withholding information.

IRAs. The 20% withholding does not apply to distributions
from any IRA, but withholding does apply to IRAs under the
rules for periodic payments and nonperiodic distributions. For
withholding, assume that the entire amount of a distribution
from an IRA other than a Roth IRA is taxable (except for the
distribution of contributions under section 408(d)(4), in which
only the earnings are taxable, and section 408(d)(5), as
applicable). Generally, Roth IRA distributions are not subject
to withholding except on the earnings portion of excess
contributions distributed under section 408(d)(4).
An IRA recharacterization is not subject to income tax
withholding.

Even though you may be using Code 1 in box 7 to
designate an early distribution subject to the 10% additional
tax specified in section 72(q), (t), or (v), you are not required
to withhold that tax.
The amount withheld cannot be more than the sum of

TIP the cash and the FMV of property (excluding

employer securities) received in the distribution. If a
distribution consists solely of employer securities and cash
($200 or less) in lieu of fractional shares, no withholding is
required.
To determine your withholding requirements for any
designated distribution under section 3405, you must first
determine whether the distribution is an eligible rollover
distribution. See Direct Rollovers, earlier, for a discussion of
eligible rollover distributions. If the distribution is not an
eligible rollover distribution, the rules for periodic payments
or nonperiodic distributions apply. For purposes of
withholding, distributions from any IRA are not eligible
rollover distributions.

Periodic payments. For periodic payments that are not
eligible rollover distributions, withhold on the taxable part as
though the periodic payments were wages, based on the
recipient's Form W-4P. The recipient may request additional
withholding on Form W-4P or claim exemption from
withholding. If a recipient does not submit a Form W-4P,
withhold by treating the recipient as married with three
withholding allowances. See Regulations section
35.3405-1T, Q/A A-9, for a definition of periodic payments.
See Pub. 15-A for additional information regarding
withholding on periodic payments and Pub. 15-T for
applicable tables used to determine withholding on periodic
payments.

Eligible rollover distribution; 20% withholding. If an
eligible rollover distribution is paid directly to an eligible
retirement plan in a direct rollover, do not withhold federal
income tax. If any part of an eligible rollover distribution is not
a direct rollover, you must withhold 20% of the part that is
paid to the recipient and includible in gross income. This
includes the earnings portion of any nonqualified designated
Roth account distribution that is not directly rolled over. The
-12-

Instructions for Forms 1099-R and 5498 (2021)

previous distributions were made, any amount recovered tax
free in prior years must not appear in box 5.

Rather than Form W-4P, military retirees should give

TIP you Form W-4, Employee's Withholding Certificate.

For payments of reportable death benefits, enter your
estimate of the buyer’s investment in the contract in box 5.

Nonperiodic distributions. Withhold 10% of the taxable
part of a nonperiodic distribution that is not an eligible rollover
distribution. In most cases, designated distributions from any
IRA are treated as nonperiodic distributions subject to
withholding at the 10% rate even if the distributions are paid
over a periodic basis. See Regulations section 35.3405-1T,
Q/A F-15. The recipient may request additional withholding
on Form W-4P or claim exemption from withholding. For
more information on nonperiodic distributions and
withholding, see Regulations section 35-3405-1T, Q/A A-12,
and parts C, D, and F.

If you are unable to reasonably obtain the data necessary
to compute the taxable amount, leave box 2a blank, leave
box 5 blank (except in the case of a payment of reportable
death benefits), and check the first box in box 2b. In the case
of a payment of reportable death benefits, box 5 must be
completed.
For more information, see Rev. Proc. 92-86, 1992-2 C.B.
495, and section 72(d).
For reporting charitable gift annuities, see Charitable gift
annuities, earlier.

Failure to provide TIN. For periodic payments and
nonperiodic distributions, if a payee fails to furnish his or her
correct TIN to you in the manner required, or if the IRS
notifies you before any distribution that the TIN furnished is
incorrect, a payee cannot claim exemption from withholding.
For periodic payments, withhold as if the payee was single
claiming no withholding allowances. For nonperiodic
payments, withhold 10%. Backup withholding does not
apply.

Box 6. Net Unrealized Appreciation (NUA) in
Employer's Securities

Use this box if a distribution from a qualified plan (except a
qualified distribution from a designated Roth account)
includes securities of the employer corporation (or a
subsidiary or parent corporation) and you can compute the
NUA in the employer's securities. Enter all the NUA in
employer securities if this is a lump-sum distribution. If this is
not a lump-sum distribution, enter only the NUA in employer
securities attributable to employee contributions. See
Regulations section 1.402(a)-1(b) for the determination of the
NUA. Also, see Notice 89-25, Q/A-1, 1989-1 C.B. 662.
Include the NUA in box 1 but not in box 2a except in the case
of a direct rollover to a Roth IRA or a designated Roth
account in the same plan (see Notice 2009-75, Q/A-1, and
Notice 2010-84, Q/A-7). You do not have to complete this
box for a direct rollover.

Box 5. Employee Contributions/Designated
Roth Contributions or Insurance Premiums

Enter the employee's contributions, designated Roth
contributions, or insurance premiums that the employee may
recover tax free this year (even if they exceed the box 1
amount). The entry in box 5 may include any of the following:
(a) designated Roth contributions or contributions actually
made on behalf of the employee over the years under the
plan that were required to be included in the income of the
employee when contributed (after-tax contributions), (b)
contributions made by the employer but considered to have
been contributed by the employee under section 72(f), (c) the
accumulated cost of premiums paid for life insurance
protection taxable to the employee in previous years and in
the current year under Regulations section 1.72-16 (cost of
current life insurance protection) (only if the life insurance
contract itself is distributed), and (d) premiums paid on
commercial annuities. Do not include any DVECs, elective
deferrals, or any contribution to a retirement plan that was not
an after-tax contribution.

Box 7. Distribution Code(s)

Enter an “X” in the IRA/SEP/SIMPLE checkbox if the
distribution is from a traditional IRA, SEP IRA, or SIMPLE
IRA. Do not check the box for a distribution from a Roth IRA
or for an IRA recharacterization.
Enter the appropriate code(s) in box 7. Use Table 1 to
determine the appropriate code(s) to enter in box 7 for any
amounts reported on Form 1099-R. Read the codes carefully
and enter them accurately because the IRS uses the codes
to help determine whether the recipient has properly reported
the distribution. If the codes you enter are incorrect, the IRS
may improperly propose changes to the recipient's taxes.
When applicable, enter a numeric and an alpha code. For
example, when using Code P for a traditional IRA distribution
under section 408(d)(4), you must also enter Code 1, if it
applies. For a normal distribution from a qualified plan that
qualifies for the 10-year tax option, enter Codes 7 and A. For
a direct rollover to an IRA or a qualified plan for the surviving
spouse of a deceased participant, or on behalf of a
nonspouse designated beneficiary, enter Codes 4 and G
(Codes 4 and H if from a designated Roth account to a Roth
IRA). If two or more distribution codes are not valid
combinations, you must file more than one Form 1099-R.

Generally, for qualified plans, section 403(b) plans, and
nonqualified commercial annuities, enter in box 5 the
employee contributions or insurance premiums recovered tax
free during the year based on the method you used to
determine the taxable amount to be entered in box 2a. On a
separate Form 1099-R, include the portion of the employee's
basis that has been distributed from a designated Roth
account. See the Examples in the instructions for box 2a,
earlier.
If periodic payments began before 1993, you are not
required to, but you are encouraged to, report in box 5.
If you made periodic payments from a qualified plan
and the annuity starting date is after November 18,
CAUTION 1996, you must use the simplified method to figure
the tax-free amount each year. See Annuity starting date in
1998 or later, earlier.

!

Enter a maximum of two alpha/numeric codes in
box 7. See Table 1 for allowable combinations. Only
CAUTION three numeric combinations are permitted on one
Form 1099-R: Codes 8 and 1, 8 and 2, or 8 and 4. If two or
more other numeric codes are applicable, you must file more
than one Form 1099-R. For example, if part of a distribution is
premature (Code 1) and part is not (Code 7), file one Form

!

If a total distribution is made, the total employee
contributions or insurance premiums available to be
recovered tax free must be shown only in box 5. If any
Instructions for Forms 1099-R and 5498 (2021)

-13-

To determine the value of an annuity contract, show the
value as an amount equal to the current actuarial value of the
annuity contract, reduced by an amount equal to the excess
of the employee's contributions over the cash and other
property (not including the annuity contract) distributed.

1099-R for the part to which Code 1 applies and another
Form 1099-R for the part to which Code 7 applies. In
addition, for the distribution of excess deferrals, parts of the
distribution may be taxable in 2 different years. File separate
Forms 1099-R using Code 8 or P to indicate the year the
amount is taxable.

If an annuity contract is part of a multiple recipient
lump-sum distribution, enter in box 8, along with the current
actuarial value, the percentage of the total annuity contract
each Form 1099-R represents.

If a qualified plan loan offset occurs in a designated
Roth account (Codes M and B), or a loan is treated
CAUTION as a deemed distribution under section 72(p) (Codes
L and B) and a numeric code is needed to indicate whether
the recipient is subject to the 10% tax under section 72(t),
omit Code M or Code L, as applicable.

!

Also, enter in box 8 the amount of the reduction in the
investment (but not below 0 (zero)) against the cash value of
an annuity contract or the cash surrender value of a life
insurance contract due to charges or payments for qualified
long-term care insurance contracts.

Even if the employee/taxpayer is age 591/2 or over, use
Code 1 if a series of substantially equal periodic payments
was modified within 5 years of the date of the first payment
(within the meaning of section 72(q)(3) or (t)(4)), if you have
been reporting distributions in previous years using Code 2.
For example, Mr. B began receiving payments that
qualified for the exception for part of a series of substantially
equal periodic payments under section 72(t)(2)(A)(iv) when
he was 57. When he was 61, Mr. B modified the payments.
Because the payments were modified within 5 years, use
Code 1 in the year the payments were modified, even though
Mr. B is over 591/2.
If you do not know that the taxpayer meets the
requirements for substantially equal periodic payments under
section 72(t)(2)(A)(iv), use Code 1 to report the payments.

Box 9a. Your Percentage of Total Distribution

If this is a total distribution and it is made to more than one
person, enter the percentage received by the person whose
name appears on Form 1099-R. You need not complete this
box for any IRA distributions or for a
direct rollover.

Box 9b. Total Employee Contributions

You are not required to enter the total employee contributions
or designated Roth contributions in box 9b. However,
because this information may be helpful to the recipient, you
may choose to report them.
If you choose to report the total employee contributions or
designated Roth contributions, do not include any amounts
recovered tax free in prior years. For a total distribution,
report the total employee contributions or designated Roth
contributions in box 5 rather than in box 9b.

For further guidance on what makes a series of
substantially equal periodic payments, see Notice
CAUTION 89-25,1989-1 C.B. 662, Q/A-12, as modified by Rev.
Rul. 2002-62, 2002-2 C.B. 710. Notice 2004-15, 2004-9
I.R.B. 526, available at IRS.gov/irb/
2004-09_IRB#NOT-2004-15, allows taxpayers to use one of
three methods in Notice 89-25, as modified by Rev. Rul.
2002-62, to determine whether a distribution from a
nonqualified annuity is part of a series of substantially equal
periodic payments under section 72(q)(2)(D).

!

Box 10. Amount Allocable to IRR Within 5 Years

Enter the amount of the distribution allocable to an IRR made
within the 5-year period beginning with the first day of the
year in which the rollover was made. Do not complete this
box if an exception under section 72(t) applies.
For further guidance on determining amounts allocable to
an IRR, see Notice 2010-84, Q/A-13.

If part of a distribution is paid in a direct rollover and part is
not, you must file a separate Form 1099-R for each part
showing the appropriate code on each form.
Governmental section 457(b) plan distributions.
Generally, a distribution from a governmental section 457(b)
plan is not subject to the 10% additional tax under section
72(t). However, an early distribution from a governmental
section 457(b) plan of an amount that is attributable to a
rollover from another type of eligible retirement plan or IRA is
subject to the additional tax as if the distribution were from a
plan described in section 401(a). See section 72(t)(9). If the
distribution consists solely of amounts that are not
attributable to such a rollover, enter Code 2 in box 7. If the
distribution consists solely of amounts attributable to such a
rollover, then enter the appropriate code in box 7 as if the
distribution were from a plan described in section 401(a). If
the distribution is made up of amounts from both sources,
you must file separate Forms 1099-R for each part of the
distribution unless Code 2 would be entered on
each form.

Box 11. 1st Year of Desig. Roth Contrib.

Enter the first year of the 5-tax-year period. This is the year in
which the designated Roth account was first established by
the recipient.

Box 12. FATCA Filing Requirement Checkbox

Check the box if you are an FFI reporting a cash value
insurance contract or annuity contract that is a U.S. account
in a manner similar to that required under section 6047(d).
See Regulations section 1.1471-4(d)(5)(i)(B) for this election.
In addition, check the box if you are a U.S. payer that is
reporting on Form 1099-R as part of satisfying your
requirement to report with respect to a U.S. account for
chapter 4 purposes, as described in Regulations section
1.1471-4(d)(2)(iii)(A).

Box 13. Date of Payment

Enter here the date payment was made for reportable death
benefits under section 6050Y.

Box 8. Other

Enter the current actuarial value of an annuity contract that is
part of a lump-sum distribution. Do not include this item in
boxes 1 and 2a.

Boxes 14–19. State and Local Information

These boxes and Copies 1 and 2 are provided for your
convenience only and need not be completed for the IRS.
-14-

Instructions for Forms 1099-R and 5498 (2021)

Use the state and local information boxes to report
distributions and taxes for up to two states or localities. Keep
the information for each state or locality separated by the
broken line. If state or local income tax has been withheld on
this distribution, you may enter it in boxes 14 and 17, as
appropriate. In box 15, enter the abbreviated name of the
state and the payer's state identification number. The state

number is the payer's identification number assigned by the
individual state. In box 18, enter the name of the locality. In
boxes 16 and 19, you may enter the amount of the state or
local distribution. Copy 1 may be used to provide information
to the state or local tax department. Copy 2 may be used as
the recipient's copy in filing a state or local income tax return.

Table 1. Guide to Distribution Codes

Guide to Distribution Codes
Distribution Codes

*Used with code ...(if
applicable)

Explanations

1—Early distribution, no known exception.

Use Code 1 only if the participant has not reached age 591/2, and you do not
8, B, D, K, L, M, or P
know if any of the exceptions under Code 2, 3, or 4 apply. However, use Code 1
even if the distribution is made for medical expenses, health insurance premiums,
qualified higher education expenses, a first-time home purchase, a qualified
reservist distribution, or a qualified birth or adoption distribution under section
72(t)(2)(B), (D), (E), (F), (G), or (H). Code 1 must also be used even if a taxpayer
is 591/2 or older and he or she modifies a series of substantially equal periodic
payments under section 72(q), (t), or (v) prior to the end of the 5-year period
which began with the first payment.

2—Early distribution, exception applies.

Use Code 2 only if the participant has not reached age 591/2 and you know the
distribution is the following.
• A Roth IRA conversion (an IRA converted to a Roth IRA).
• A distribution made from a qualified retirement plan or IRA because of an IRS
levy under section 6331.
• A governmental section 457(b) plan distribution that is not subject to the
additional 10% tax. But see Governmental section 457(b) plans, earlier, for
information on distributions that may be subject to the 10% additional tax.
• A distribution from a qualified retirement plan after separation from service in
or after the year the participant has reached age 55.
• A distribution from a governmental defined benefit plan to a public safety
employee (as defined in section 72(t)(10)(B)) after separation from service, in or
after the year the employee has reached age 50.
• A distribution that is part of a series of substantially equal periodic payments,
as described in section 72(q), (t), (u), or (v).
• A distribution that is a permissible withdrawal under an eligible automatic
contribution arrangement (EACA).
• Any other distribution subject to an exception under section 72(q), (t), (u), or
(v) that is not required to be reported using Code 1, 3, or 4.

8, B, D, K, L, M, or P

3—Disability.

For these purposes, see section 72(m)(7).

D

4—Death.

Use Code 4 regardless of the age of the participant to indicate payment to a
8, A, B, D, G, H, K, L, M, or P
decedent's beneficiary, including an estate or trust. Also, use it for death benefit
payments made by an employer but not made as part of a pension, profit-sharing,
or retirement plan. Also, use it for payments of reportable death benefits.

5—Prohibited transaction.

Use Code 5 if there was a prohibited transaction involving the IRA account. Code
5 means the account is no longer an IRA.

None

6—Section 1035 exchange.

Use Code 6 to indicate the tax-free exchange of life insurance, annuity, long-term
care insurance, or endowment contracts under section 1035.

W

Instructions for Forms 1099-R and 5498 (2021)

-15-

Guide to Distribution Codes
Distribution Codes

*Used with code ...(if
applicable)

Explanations

7—Normal distribution.

Use Code 7: (a) for a normal distribution from a plan, including a traditional IRA,
section 401(k), or section 403(b) plan, if the employee/taxpayer is at least age
591/2; (b) for a Roth IRA conversion if the participant is at least age 591/2; and (c)
to report a distribution from a life insurance, annuity, or endowment contract and
for reporting income from a failed life insurance contract under section 7702(g)
and (h). See Rev. Proc. 2008-42, 2008-29 I.R.B. 160, available at IRS.gov/irb/
2008-29_IRB#RP-2008-42. Generally, use Code 7 if no other code applies. Do
not use Code 7 for a Roth IRA.
Note. Code 1 must be used even if a taxpayer is 591/2 or older and he or she
modifies a series of substantially equal periodic payments under section 72(q),
(t), or (v) prior to the end of the 5-year period which began with the first payment.

A, B, D, K, L, or M

8—Excess contributions plus earnings/excess
deferrals (and/or earnings) taxable in 2021.

Use Code 8 for an IRA distribution under section 408(d)(4), unless Code P
applies. Also, use this code for corrective distributions of excess deferrals,
excess contributions, and excess aggregate contributions, unless Code P
applies. See Corrective Distributions, earlier, and IRA Revocation or Account
Closure, earlier, for more information.

1, 2, 4, B, J, or K

9—Cost of current life insurance protection.

Use Code 9 to report premiums paid by a trustee or custodian for current life or
other insurance protection. See the instructions for Box 2a, earlier, for more
information.

None

A—May be eligible for 10-year tax option.

Use Code A only for participants born before January 2, 1936, or their
beneficiaries to indicate the distribution may be eligible for the 10-year tax option
method of computing the tax on lump-sum distributions (on Form 4972, Tax on
Lump-Sum Distributions). To determine whether the distribution may be eligible
for the tax option, you need not consider whether the recipient used this method
(or capital gain treatment) in the past.

4 or 7

B—Designated Roth account distribution.

Use Code B for a distribution from a designated Roth account. But use Code E
for a section 415 distribution under EPCRS (see Code E) or Code H for a direct
rollover to a Roth IRA.

1, 2, 4, 7, 8, G, L, M, P, or U

C—Reportable death benefits under section
6050Y.

Use Code C for a distribution to report payments of reportable death benefits.

D

D—Annuity payments from nonqualified annuities
and distributions from life insurance contracts
that may be subject to tax under section 1411.

Use Code D for a distribution from any plan or arrangement not described in
section 401(a), 403(a), 403(b), 408, 408A, or 457(b).

1, 2, 3, 4, 7, or C

E—Distributions under Employee Plans
Compliance Resolution System (EPCRS).

See Distributions Under Employee Plans Compliance Resolution System
(EPCRS), earlier.

None

F—Charitable gift annuity.

See Charitable gift annuities, earlier.

None

G—Direct rollover and direct payment.

Use Code G for a direct rollover from a qualified plan, a section 403(b) plan, or a
governmental section 457(b) plan to an eligible retirement plan (another qualified
plan, a section 403(b) plan, a governmental section 457(b) plan, or an IRA). See
Direct Rollovers, earlier. Also, use Code G for a direct payment from an IRA to an
accepting employer plan, and for IRRs that are direct rollovers.
Note. Do not use Code G for a direct rollover from a designated Roth account to
a Roth IRA. Use Code H.

4, B, or K

H—Direct rollover of a designated Roth account
distribution to a Roth IRA.

Use Code H for a direct rollover of a distribution from a designated Roth account
to a Roth IRA.

4

J—Early distribution from a Roth IRA.

Use Code J for a distribution from a Roth IRA when Code Q or Code T does not
apply. But use Code 2 for an IRS levy and Code 5 for a prohibited transaction.

8 or P

K—Distribution of traditional IRA assets not
having a readily available FMV.

Use Code K to report distributions of IRA assets not having a readily available
FMV. These assets may include:
• Stock, other ownership interest in a corporation, short- or long-term debt
obligations, not readily tradable on an established securities market;
• Ownership interest in a limited liability company (LLC), partnership, trust, or
similar entity (unless the interest is traded on an established securities market);
• Real estate;
• Option contracts or similar products not offered for trade on an established
option exchange; or
• Other asset that does not have a readily available FMV.

1, 2, 4, 7, 8, or G

-16-

Instructions for Forms 1099-R and 5498 (2021)

Guide to Distribution Codes
Distribution Codes

*Used with code ...(if
applicable)

Explanations

L—Loans treated as deemed distributions under
section 72(p).

Do not use Code L to report a plan loan offset. See Loans Treated as
Distributions, earlier.

1, 2, 4, 7, or B

M—Qualified plan loan offset.

Use Code M for a qualified plan loan offset (which is generally a type of plan loan
offset due to severance from employment or termination of the plan). See Plan
loan offsets, earlier.

1, 2, 4, 7, or B

N—Recharacterized IRA contribution made for
2021.

Use Code N for a recharacterization of an IRA contribution made for 2021 and
recharacterized in 2021 to another type of IRA by a trustee-to-trustee transfer or
with the same trustee.

None

P—Excess contributions plus earnings/excess
deferrals taxable in 2020.

See the explanation for Code 8. The IRS suggests that anyone using Code P for
the refund of an IRA contribution under section 408(d)(4), including excess Roth
IRA contributions, advise payees, at the time the distribution is made, that the
earnings are taxable in the year in which the contributions were made.

1, 2, 4, B, or J

Q—Qualified distribution from a Roth IRA.

Use Code Q for a distribution from a Roth IRA if you know that the participant
meets the 5-year holding period and:
• The participant has reached age 591/2,
• The participant died, or
• The participant is disabled.
Note. If any other code, such as 8 or P, applies, use Code J.

None

R—Recharacterized IRA contribution made for
2020.

Use Code R for a recharacterization of an IRA contribution made for 2020 and
recharacterized in 2021 to another type of IRA by a trustee-to-trustee transfer or
with the same trustee.

None

S—Early distribution from a SIMPLE IRA in the
first 2 years, no known exception.

Use Code S only if the distribution is from a SIMPLE IRA in the first 2 years, the
None
employee/taxpayer has not reached age 591/2, and none of the exceptions under
section 72(t) is known to apply when the distribution is made. The 2-year period
begins on the day contributions are first deposited in the individual's SIMPLE IRA.
Do not use Code S if Code 3 or 4 applies.

T—Roth IRA distribution, exception applies.

Use Code T for a distribution from a Roth IRA if you do not know if the 5-year
holding period has been met but:
• The participant has reached age 591/2,
• The participant died, or
• The participant is disabled.
Note. If any other code, such as 8 or P, applies, use Code J.

U—Dividends distributed from an ESOP under
section 404(k).

Use Code U for a distribution of dividends from an employee stock ownership
B
plan (ESOP) under section 404(k). These are not eligible rollover distributions.
Note. Do not report dividends paid by the corporation directly to plan participants
or their beneficiaries. Continue to report those dividends on Form 1099-DIV.

W—Charges or payments for purchasing qualified Use Code W for charges or payments for purchasing qualified long-term care
long-term care insurance contracts under
insurance contracts under combined arrangements which are excludable under
combined arrangements.
section 72(e)(11) against the cash value of an annuity contract or the cash
surrender value of a life insurance contract.

None

6

*See the first two Cautions for box 7 instructions, earlier.

Specific Instructions for Form 5498

!

File Form 5498, IRA Contribution Information, with the IRS by
May 31, 2022, for each person for whom in 2021 you
maintained any individual retirement arrangement (IRA),
including a deemed IRA under section 408(q).

CAUTION

Report contributions to a Kay Bailey Hutchison Spousal
IRA under section 219(c) on a separate Form 5498 using the
name and TIN of the spouse.
For contributions made between January 1 and April 18,
2022, trustees and issuers should obtain the participant's
designation of the year for which the contributions are made.

An IRA includes all investments under one IRA plan. It is
not necessary to file a Form 5498 for each investment under
one plan. For example, if a participant has three certificates
of deposit (CDs) under one IRA plan, only one Form 5498 is
required for all contributions and the fair market values
(FMVs) of the CDs under the plan. However, if a participant
has established more than one IRA plan with the same
trustee, a separate Form 5498 must be filed for each plan.

Direct rollovers, transfers, and recharacterizations. You
must report the receipt of a direct rollover from a qualified
plan, section 403(b) plan, or governmental section 457(b)
plan to an IRA. Report a direct rollover in box 2. For
information on direct rollovers of eligible rollover distributions,
see Direct Rollovers, earlier.
If a rollover or trustee-to-trustee transfer is made from a
savings incentive match plan for employees (SIMPLE) IRA to
an IRA that is not a SIMPLE IRA and the trustee has
adequately substantiated information that the participant has
not satisfied the first 2 years of plan participation, report the

Contributions. You must report contributions to any IRA on
Form 5498. See the instructions under boxes 1, 2, 3, 4, 8, 9,
10, 13a, and 14a, later. If no reportable contributions were
made for 2021, complete only boxes 5 and 7, and boxes 11,
12a, 12b, 15a, and 15b, if applicable. See Reporting FMV of
certain specified assets, later.
Instructions for Forms 1099-R and 5498 (2021)

You are required to file Form 5498 even if required
minimum distributions (RMDs) or other annuity or
periodic payments have started.

-17-

SEP IRA, or SIMPLE IRA contributions to the IRA. For
information about reporting a distribution from a revoked or
closed IRA, see IRA Revocation or Account Closure, in the
Specific Instructions for Form 1099-R, earlier.

amount as a regular contribution in box 1 even if the amount
exceeds $6,000 ($7,000 for participants 50 or older).
Transfers. Do not report on Form 5498 a
trustee-to-trustee transfer from (a) a traditional IRA or a
simplified employee pension (SEP) IRA to another traditional
IRA or SEP IRA, or to a SIMPLE IRA after the first 2 years of
plan participation; (b) a SIMPLE IRA to another SIMPLE IRA,
or to a traditional IRA or SEP IRA after the first 2 years of plan
participation; or (c) a Roth IRA to another Roth IRA.
Recharacterizations. You must report each
recharacterization of an IRA contribution. If a participant
makes a contribution to an IRA (first IRA) for a year, the
participant may choose to recharacterize the contribution by
transferring, in a trustee-to-trustee transfer, any part of the
contribution (plus earnings) to another IRA (second IRA). The
contribution is treated as made to the second IRA
(recharacterization). A recharacterization may be made with
the same trustee or with another trustee. The trustee of the
first IRA must report the amount contributed before the
recharacterization as a contribution on Form 5498 and the
recharacterization as a distribution on Form 1099-R. The
trustee of the second IRA must report the amount received
(FMV) in box 4 on Form 5498 and check the type of IRA in
box 7.
All recharacterized contributions received by an IRA in the
same year must be totaled and reported on one Form 5498 in
box 4. You may report the FMV of the account on the same
Form 5498 you use to report a recharacterization of an IRA
contribution and any other contributions made to the IRA for
the year.

Total distribution, no contributions. Generally, if a total
distribution was made from an account during the year and
no contributions, including rollovers, recharacterizations, or
Roth IRA conversion amounts, were made for that year, you
need not file Form 5498 nor furnish the annual statement to
reflect that the FMV on December 31 was zero.
RMDs. An IRA (other than a Roth IRA) owner/participant
must begin taking distributions for each calendar year
beginning with the calendar year in which the participant
attains age 72 (age 701/2 if the participant attained age 701/2
before 2020). The distribution for the 72 (age 701/2, if
applicable) year must be made no later than April 1 of the
following calendar year; RMDs for any other year must be
made no later than December 31 of the year. See
Regulations section 1.401(a)(9)-6 for RMDs from annuity
contracts.
For each IRA you held as of December 31 of the prior
year, if an RMD is required for the year, you must provide a
statement to the IRA participant by January 31 regarding the
RMD using one of two alternative methods described below.
You are not required to use the same method for all IRA
participants; you can use Alternative one for some IRA
participants and Alternative two for the rest. Under both
methods, the statement must inform the participant that you
are reporting to the IRS that an RMD is required for the year.
The statement can be provided in conjunction with the
statement of the FMV.

No recharacterizations of conversions made in 2018 or
later. A conversion of a traditional IRA to a Roth IRA, and a
rollover from any other eligible retirement plan to a Roth IRA,
made in the participant’s tax years beginning after December
31, 2017, cannot be recharacterized as having been made to
a traditional IRA. Conversions made in the 2017 tax year may
be recharacterized by the due date (with extensions) for filing
the return for that tax year.

If the IRA participant is deceased, and the surviving
spouse is the sole beneficiary, special rules apply for RMD
reporting. If the surviving spouse elects to treat the IRA as
the spouse's own, then report with the surviving spouse as
the owner. However, if the surviving spouse does not elect to
treat the IRA as the spouse's own, then you must continue to
treat the surviving spouse as the beneficiary. Until further
guidance is issued, no reporting is required for IRAs of
deceased participants (except where the surviving spouse
elects to treat the IRA as the spouse's own, as described
above).
Alternative one. Under this method, include in the
statement the amount of the RMD with respect to the IRA for
the calendar year and the date by which the distribution must
be made. The amount may be calculated assuming the sole
beneficiary of the IRA is not a spouse more than 10 years
younger than the participant. Use the value of the account as
of December 31 of the prior year to compute the amount. See
the instructions for boxes 11, 12a, and 12b, later, for how to
report.
Alternative two. Under this method, the statement
informs the participant that a minimum distribution with
respect to the IRA is required for the calendar year and the
date by which such amount must be distributed. You must
include an offer to furnish the participant with a calculation of
the amount of the RMD if requested by the participant.
Electronic filing. These statements may be furnished
electronically using the procedures described in part F of the
2021 General Instructions for Certain Information Returns.
Reporting to the IRS. If an RMD is required, check
box 11. See Box 11, later. For example, box 11 is checked
on the Form 5498 for a 2022 RMD. You are not required to
report to the IRS the amount or the date by which the

Catch-up contributions. Participants who are age 50 or
older by the end of the year may be eligible to make catch-up
IRA contributions or catch-up elective deferral contributions.
The annual IRA regular contribution limit of $6,000 is
increased to $7,000 for participants age 50 or older.
Catch-up elective deferral contributions reported on Form
5498 may be made under a salary reduction SEP (SARSEP)
or under a SIMPLE IRA plan. For 2021, up to $6,500 in
catch-up elective deferral contributions may be made under a
SARSEP, and up to $3,000 to a SIMPLE IRA plan. For more
information on catch-up elective deferral contributions, see
Regulations section 1.414(v)-1.
Include any catch-up amounts when reporting
contributions for the year in box 1, 8, 9, or 10, or for a prior
year in box 13a.
Roth IRA conversions. You must report the receipt of a
conversion from an IRA to a Roth IRA even if the conversion
is with the same trustee. Report the total amount converted
from a traditional IRA, SEP IRA, or SIMPLE IRA to a Roth
IRA in box 3.
IRA revocation or account closure. If a traditional IRA,
Roth IRA, or SIMPLE IRA is revoked during its first 7 days
(under Regulations section 1.408-6(d)(4)(ii)) or closed at any
time by the IRA trustee pursuant to its resignation or such
other event mandating the closure of the account, Form 5498
must be filed to report any regular, rollover, IRA conversion,
-18-

Instructions for Forms 1099-R and 5498 (2021)

In the case of successor beneficiaries, apply the
preceding rules by treating the prior beneficiary as the
decedent and the successor beneficiary as the beneficiary.
Using the example above (Brian Willow as beneficiary of
Joan Maple), when that account passes to Brian's successor
beneficiary, Maurice Poplar, Form 5498 and the annual
statement for Maurice should state “Maurice Poplar as
beneficiary of Brian Willow.” The final Form 5498 and annual
statement for Brian Willow will state “Brian Willow as
beneficiary of Joan Maple” and will show the FMV as of the
date of Brian's death or year-end valuation, depending on the
method chosen.
For more information about the reporting requirements for
inherited IRAs, see Rev. Proc. 89-52, 1989-2 C.B. 632.

distribution must be made. However, see the Caution
following the box 11 instructions, later, for reporting RMDs to
participants.
For more details, see Notice 2002-27 on page 814 of
Internal Revenue Bulletin 2002-18 at IRS.gov/pub/irs-irbs/
irb02-18.pdf, as clarified by Notice 2003-3 on page 258 of
Internal Revenue Bulletin 2003-2 at IRS.gov/pub/irs-irbs/
irb03-02.pdf.

!

Notices 2002-27 and 2003-3 do not reflect the RMD
change from age 701/2 to age 72.

CAUTION

Inherited IRAs. In the year an IRA participant dies, you, as
an IRA trustee or issuer, generally must file a Form 5498 and
furnish an annual statement for the decedent and a Form
5498 and an annual statement for each nonspouse
beneficiary. An IRA holder must be able to identify the source
of each IRA he or she holds for purposes of figuring the
taxation of a distribution from an IRA. Thus, the decedent's
name must be shown on the beneficiary's Form 5498 and
annual statement. For example, you may enter “Brian Willow
as beneficiary of Joan Maple” or something similar that
signifies that the IRA was once owned by Joan Maple. You
may abbreviate the word “beneficiary” as, for example,
“bene.”
For a spouse beneficiary, unless the spouse makes the
IRA his or her own, treat the spouse as a nonspouse
beneficiary for reporting purposes. If the spouse makes the
IRA his or her own, do not report the beneficiary designation
on Form 5498 and the annual statement.
An IRA set up to receive a direct rollover for a nonspouse
designated beneficiary is treated as an inherited IRA.
FMV. On the decedent's Form 5498 and annual
statement, you must enter the FMV of the IRA on the date of
death in box 5. Or you may choose the alternate reporting
method and report the FMV as of the end of the year in which
the decedent died. This alternate value will usually be zero
because you will be reporting the end-of-year valuation on
the beneficiary's Form 5498 and annual statement. The same
figure should not be shown on both the beneficiary's and
decedent's forms. If you choose to report using the alternate
method, you must inform the executor or administrator of the
decedent's estate of his or her right to request a
date-of-death valuation.
On the beneficiary's Form 5498 and annual statement, the
FMV of that beneficiary's share of the IRA as of the end of the
year must be shown in box 5. Every year thereafter that the
IRA exists, you must file Form 5498 and furnish an annual
statement for each beneficiary who has not received a total
distribution of his or her share of the IRA showing the FMV at
the end of the year and identifying the IRA, as described
above.
However, if a beneficiary takes a total distribution of his or
her share of the IRA in the year of death, you need not file a
Form 5498 nor furnish an annual statement for that
beneficiary, but you must still file Form 5498 for the
decedent.
If you have no knowledge of the death of an IRA
participant until after you are required to file Form 5498 (May
31, 2022), you are not required to file a corrected Form 5498
nor furnish a corrected annual statement. However, you must
still provide the date-of-death valuation in a timely manner to
the executor or administrator upon request.

Instructions for Forms 1099-R and 5498 (2021)

Disaster relief reporting. Special tax law provisions and
reporting instructions may apply when the President declares
a location to be a major disaster area. To determine the
location of and special rules applicable to individual federally
declared disaster areas, go to IRS.gov, click on “News,” then
click on “Tax Relief in Disaster Situations.” The information
provided includes:
• A list of the areas for which relief has recently been
granted,
• News releases detailing the scope of the relief and any
special reporting instructions, and
• A link to the Federal Emergency Management Agency's
list of federal disaster declarations. Also, go to IRS.gov/
DisasterRelief for more information.
See the instructions for boxes 13a through 13c for
reporting postponed contributions, later.
Special reporting for U.S. Armed Forces in designated
combat zones. A participant who is serving in or in support
of the Armed Forces in a designated combat zone or
qualified hazardous duty area has an additional period after
the normal contribution due date of April 15 to make IRA
contributions for a prior year. The period is the time the
participant was in the designated zone or area plus at least
180 days. The participant must designate the IRA
contribution for a prior year to claim it as a deduction on the
income tax return.
Under section 219(f), combat zone compensation that is
excluded from gross income under section 112 is treated as
includible compensation for purposes of determining IRA
contributions.
A qualifying participant is:
• Serving, or has served in a combat zone;
• Serving, or has served in a qualifying hazardous duty area;
or
• Serving, or has served in an active direct support area.
If a qualifying participant designates an IRA contribution
for a prior year, other than an IRA contribution made by April
15 for the preceding year, you must report the type of IRA
(box 7) and the amount on Form 5498. Report the amount
either for (1) the year for which the contribution was made, or
(2) a subsequent year. See the instructions for boxes 13a,
13b, and 13c, later.
1. If you report a contribution for 2021 made before April
18, 2022, no special reporting is required. Include the
contribution in box 1 or box 10 of an original Form 5498 or of
a corrected Form 5498 if an original was previously filed.
2. If you report the contribution on Form 5498 in a
subsequent year, you must include the year for which the

-19-

prior year contributions by combat zone participants on a
corrected Form 5498 electronically or on paper.
See part F in the 2021 General Instructions for Certain
Information Returns for information on how to request a
waiver on Form 8508.

contribution was made, the amount of the contribution, and
one of the following indicators.
a. Use “EO13239” for Afghanistan and those countries in
direct support, including Djibouti, Jordan, Kyrgyzstan,
Pakistan, Somalia, Syria, Tajikistan, Uzbekistan, Yemen, and
the Philippines. For the Philippines only, personnel must be
deployed in conjunction with Operation Enduring Freedom
supporting military operations in the Afghanistan combat
zone.
b. Use “EO12744” for the Arabian Peninsula, including air
space and adjacent waters (the Persian Gulf, the Red Sea,
the Gulf of Oman, the Gulf of Aden, the portion of the Arabian
Sea that lies north of 10 degrees north latitude and west of 68
degrees east longitude, and the total land areas of Iraq,
Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, and the United
Arab Emirates), and Jordan which is in direct support of the
Arabian Peninsula.
c. Use “EO13119” or Public Law 106-21 “PL106-21” for
the Federal Republic of Yugoslavia (Serbia and
Montenegro), Albania, Kosovo, the Adriatic Sea, and the
Ionian Sea north of the 39th parallel. (Note. The combat zone
designation for Montenegro and Kosovo (previously a
province within Serbia) under Executive Order 13119
remains in force even though Montenegro and Kosovo
became independent nations since EO13119 was signed.)
d. Use Public Law 115-97 “PL115-97” for the Sinai
Peninsula of Egypt.

Reporting FMV of certain specified assets. Assets held
in an IRA that are not readily tradable on an established
securities market or option exchange, or that do not have a
readily available FMV, must be reported at the FMV
determined as of December 31, 2021. See the instructions
for boxes 15a and 15b, later.
Corrected Form 5498. If you file a Form 5498 with the IRS
and later discover that there is an error on it, you must correct
it as soon as possible. See part H in the 2021 General
Instructions for Certain Information Returns, or Pub. 1220, if
filing electronically. For example, if you reported contributions
as rollover contributions in box 2, and you later discover that
part of the contribution was not eligible to be rolled over and
was, therefore, a regular contribution that should have been
reported in box 1 (even if the amount exceeds the regular
contribution limit), you must file a corrected Form 5498.
Statements to participants. If you are required to file Form
5498, you must provide a statement to the participant. By
January 31, 2022, you must provide participants with a
statement of the December 31, 2021, value of the
participant's account (including information required to be
reported in boxes 15a and 15b for hard-to-value assets) and
RMD, if applicable. Trustees of SIMPLE IRAs must also
provide a statement of the account activity by January 31,
2022. Contribution information for all other types of IRAs
must be provided by May 31, 2022. You are not required to
provide information to the IRS or to participants as to whether
a contribution is deductible or nondeductible. In addition, the
participant is not required to tell you whether a contribution is
deductible or nondeductible.
If you furnished a statement of the FMV of the account
(including information required to be reported in boxes 15a
and 15b for hard-to-value assets) and RMD, if applicable, to
the participant by January 31, 2022, and no reportable
contributions, including rollovers, recharacterizations, or Roth
IRA conversions, were made for 2021, you need not furnish
another statement (or Form 5498) to the participant to report
zero contributions. However, you must file Form 5498 with
the IRS by May 31, 2022, to report the December 31, 2021,
FMV of the account and the FMV of hard-to-value assets.
This rule also applies to beneficiary accounts under the
inherited IRA rules, earlier. For more information about the
requirement to furnish statements to participants, see part M
in the 2021 General Instructions for Certain Information
Returns.

For additions to, or subtractions from, the list of
combat zones or qualified hazardous duty areas
CAUTION implemented by executive orders and public laws,
and direct support areas designated by the Secretary of
Defense, after the publication date of these instructions, go to
IRS.gov/Form5498.

!

Example. For a $4,000 IRA contribution designated by a
participant who served under EO13239 for the tax year 2016,
enter “4000” in box 13a, “2016” in box 13b, and “EO13239” in
box 13c only. Make no entry in box 1 or box 10.
Repayment of qualified reservist distributions. Report
any repayment of a qualified reservist distribution as
described in section 72(t)(2)(G) in boxes 14a (amount) and
14b (with indicator code “QR”).
Repayment of qualified birth or adoption
distributions. Report any repayment of a qualified birth or
adoption distribution as described in section 72(t)(2)(H) in
boxes 14a (amount) and 14b (with indicator code "BA").
Military death gratuities and servicemembers' group
life insurance (SGLI) payments. Recipients of military
death gratuities and SGLI payments may contribute amounts
received to a Roth IRA, up to the amount of the gratuity or
SGLI payment less any amounts contributed to Coverdell
ESAs. Report the amount of the rollover contribution in box 2
only. See section 408A(e)(2), and Notice 2010-15, 2010-06
I.R.B. 390, available at IRS.gov/irb/
2010-06_IRB#NOT-2010-15, for more information on
limitations.
Electronic filers. You may request an automatic waiver
from filing Forms 5498 for combat zone participants by
submitting Form 8508, Request for Waiver From Filing
Information Returns Electronically. Once you have received
the waiver, you may report all Forms 5498 for combat zone
participants on paper. Alternatively, you may report
contributions made by the normal contribution due date
electronically and report the contributions made after the
normal contribution due date on paper. You may also report

If you do not furnish another statement to the
participant because no reportable contributions were
CAUTION made for the year, the statement of the FMV of the
account must contain a legend designating which information
is being filed with the IRS.

!

Truncating taxpayer participant's TIN on payee statements. Pursuant to Regulations section 301.6109-4, all
filers of Form 5498 may truncate a participant’s TIN (social
security number (SSN), individual taxpayer identification
number (ITIN), adoption taxpayer identification number
(ATIN), or employer identification number (EIN)) on payee
statements. Truncation is not allowed on any documents the
filer files with the IRS. A trustee's or issuer's TIN may not be
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Instructions for Forms 1099-R and 5498 (2021)

• Qualified birth or adoption distributions.
See the instructions for boxes 13a through 13c, 14a, and
14b, later.

truncated on any form. See part J in the 2021 General
Instructions for Certain Information Returns.

Account Number

Box 3. Roth IRA Conversion Amount

The account number is required if you have multiple
accounts for a recipient for whom you are filing more than
one Form 5498. Additionally, the IRS encourages you to
designate an account number for all Forms 5498 that you file.
See part L in the 2021 General Instructions for Certain
Information Returns.

Enter the amount converted from a traditional IRA, SEP IRA,
or SIMPLE IRA to a Roth IRA during 2021. Do not include a
rollover from one Roth IRA to another Roth IRA, or a qualified
rollover contribution under section 408A(e) from an eligible
retirement plan (other than an IRA) to a Roth IRA. These
rollovers are reported in box 2.

Box 1. IRA Contributions (Other Than Amounts
in Boxes 2–4, 8–10, 13a, and 14a)

Box 4. Recharacterized Contributions

Enter contributions to a traditional IRA made in 2021 and
through April 18, 2022, designated for 2021.

Enter any amounts recharacterized plus earnings from one
type of IRA to another.

Report gross contributions, including the amount allocable
to the cost of life insurance (see Box 6, later) and including
any excess contributions, even if the excess contributions
were withdrawn. If an excess contribution is treated as a
contribution in a subsequent year under section 219(f)(6), do
not report it on Form 5498 for the subsequent year. It has
already been reported as a contribution on Form 5498 for the
year it was actually contributed.

Box 5. Fair Market Value of Account

Enter the FMV of the account on December 31, 2021. For
inherited IRAs, see Inherited IRAs, earlier.
Trustees and custodians are responsible for ensuring
that all IRA assets (including those not traded on
CAUTION established markets or not having a readily
determinable market value) are valued annually at their FMV.

!

Also include employee contributions to an IRA under a
SEP plan. These are contributions made by the employee,
not by the employer, that are treated as regular IRA
contributions subject to the 100% of compensation and
$6,000 ($7,000 for participants 50 or older) limits of section
219. Do not include employer SEP IRA contributions or
SARSEP contributions under section 408(k)(6). Instead,
include them in box 8.

Box 6. Life Insurance Cost Included in Box 1

For endowment contracts only, enter the amount included in
box 1 allocable to the cost of life insurance.

Box 7. Checkboxes

Check the appropriate box.
IRA. Check “IRA” if you are filing Form 5498 to report
information about a traditional IRA account.

Also, do not include in box 1 employer contributions,
including salary deferrals, to a SIMPLE IRA (report them in
box 9) and a Roth IRA (report them in box 10). In addition, do
not include in box 1 rollovers and recharacterizations (report
rollovers in box 2 and recharacterizations in box 4), or a Roth
IRA conversion amount (report in box 3).

SEP. Check “SEP” if you are filing Form 5498 to report
information about a SEP IRA. If you do not know whether the
account is a SEP IRA, check the “IRA” box.
SIMPLE. Check “SIMPLE” if you are filing Form 5498 to
report information about a SIMPLE IRA account. Do not file
Form 5498 for a SIMPLE 401(k) plan.

Box 2. Rollover Contributions

Enter any rollover contributions (or contributions treated as
rollovers) to any IRA received by you during 2021. These
contributions may be any of the following.
• A 60-day rollover between Roth IRAs or between other
types of IRAs.
• A direct or indirect (within 60 days) rollover from a qualified
plan, section 403(b) plan, or governmental section 457(b)
plan.
• Any qualified rollover contribution, as defined in section
408A(e) from an eligible retirement plan (other than an IRA)
to a Roth IRA.
• A military death gratuity.
• An SGLI payment.

Roth IRA. Check “Roth IRA” if you are filing Form 5498 to
report information about a Roth IRA account.

Box 8. SEP Contributions

Enter employer contributions made to a SEP IRA (including
salary deferrals under a SARSEP) during 2021, including
contributions made in 2021 for 2020, but not including
contributions made in 2022 for 2021. Trustees and issuers
are not responsible for reporting the year for which SEP
contributions are made. Do not enter employee contributions
to an IRA under a SEP plan. Report any employee
contributions to an IRA under a SEP plan in box 1. Also,
include in box 8 SEP contributions made by a self-employed
person to his or her own account.

For the rollover of property, enter the FMV of the property
on the date you receive it. This value may be different from
the value of the property on the date it was distributed to the
participant.

Box 9. SIMPLE Contributions

Enter employer contributions, including salary deferrals,
made to a SIMPLE IRA during 2021, including contributions
made in 2021 for 2020, but not including contributions made
in 2022 for 2021. Trustees and issuers are not responsible
for reporting the year for which SIMPLE contributions are
made. Do not include contributions to a SIMPLE 401(k) plan.

For more details, see Pub. 590-A.
Note. Do not use box 2 for late rollover contributions,
including rollovers of qualified plan loan offset amounts after
60 days or any of the following repayments made after 60
days.
• Qualified reservist distributions.
• Qualified disaster distributions.
Instructions for Forms 1099-R and 5498 (2021)

-21-

• For participants' service in a combat zone, hazardous duty
area, or direct support area, enter the appropriate executive
order or public law, as defined under Special reporting for
U.S. Armed Forces in designated combat zones, earlier.
• For participants who are “affected taxpayers,” as
described in an IRS News Release relating to a federally
designated disaster area, enter “FD.” (For a repayment of a
qualified disaster distribution, use box 14a.)
• For participants who are making a rollover of a qualified
plan loan offset amount, enter “PO.” See the discussion of
qualified plan loan offsets in the second paragraph under the
heading Plan Loan Offsets in the Form 1099-R instructions.
• For participants who have certified that the rollover
contribution is late because of one or more of the
circumstances listed in section 3.02(2) of Rev. Proc.
2020-46, enter “SC.”

Box 10. Roth IRA Contributions

Enter any contributions made to a Roth IRA in 2021 and
through April 18, 2022, designated for 2021. However, report
Roth IRA conversion amounts in box 3. Report a qualified
rollover contribution made under section 408A(e) from an
eligible retirement plan (other than an IRA) to a Roth IRA in
box 2.

Box 11. Check if RMD for 2022

Check the box if the participant must take an RMD for 2022.
You are required to check the box for the year in which the
IRA participant reaches age 72 (age 701/2 if the participant
attained age 701/2 before 2020) even though the RMD for
that year need not be made until April 1 of the following year.
Then, check the box for each subsequent year an RMD is
required to be made.

Box 14a. Repayments

Boxes 12a and 12b are provided for your use to
report RMD dates and amounts to participants. You
CAUTION may choose to complete these boxes, or continue to
provide a separate Form 5498, or a separate statement, to
report the information required by Alternative one or
Alternative two, earlier. To determine the RMD, see the
regulations under sections 401(a)(9) and 408(a)(6) and (b)
(3).

Enter the amount of any repayment of a qualified reservist
distribution, a qualified disaster distribution (for example, a
qualified 2020 disaster distribution), or a qualified birth or
adoption distribution.

!

Box 14b. Code

Enter “QR” for the repayment of a qualified reservist
distribution, “DD” for repayment of a qualified disaster
distribution, or “BA” for repayment of a qualified birth or
adoption distribution.

Box 12a. RMD Date

Enter the RMD date if you are using Form 5498 to report the
additional information. See RMDs, earlier.

Box 15a. FMV of Certain Specified Assets

Box 12b. RMD Amount

Enter the FMV of the investments in the IRA that are
specified in the categories identified below.

Enter the RMD amount if you are using Form 5498 to report
the additional information under Alternative one. See
Alternative one, earlier.

Box 15b. Code(s)

Enter the code for the type(s) of investments held in the IRA
for which the FMV is reported in box 15a. A maximum of two
codes can be entered in box 15b. If more than two codes
apply, enter Code H.
• A—Stock or other ownership interest in a corporation that
is not readily tradable on an established securities market.
• B—Short- or long-term debt obligation that is not traded on
an established securities market.
• C—Ownership interest in a limited liability company or
similar entity (unless the interest is traded on an established
securities market).
• D—Real estate.
• E—Ownership interest in a partnership, trust, or similar
entity (unless the interest is traded on an established
securities market).
• F—Option contract or similar product that is not offered for
trade on an established option exchange.
• G—Other asset that does not have a readily available
FMV.
• H—More than two types of assets (listed in A through G)
are held in this IRA.

Box 13a. Postponed/late Contrib.

Report the amount of any postponed contribution made in
2021 for a prior year. If contributions were made for more
than 1 prior year, each prior year's postponed contribution
must be reported on a separate form. Report the amount of a
late rollover contribution made during 2021, including
rollovers that are (1) certified by participants, (2) qualified
plan loan offsets, and (3) related to taxpayers for federally
declared disasters. See Rev. Proc. 2020-46, 2020-45 I.R.B.
995, available at IRS.gov/irb/2020-45_IRB#REVPROC-2020-46. If the participant also has a postponed
contribution, use a separate Form 5498 to report a late
rollover.

Box 13b. Year

Enter the year for which the postponed contribution in
box 13a was made. Leave this box blank for late rollover
contributions and rollovers of qualified plan loan offset
amounts.

Box 13c. Code

Enter the reason the participant made the postponed
contribution.

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Instructions for Forms 1099-R and 5498 (2021)

Index
A
Account closure, IRA 3, 18
Alternate payee under QDRO 8
Annuity distributions 1–15
Automatic contribution arrangements 6
Automatic rollovers 4, 5
B
Beneficiaries 8
C
Charitable gift annuities 9
Combat zones, designated 19
Corrected Form 1099-R 8
Corrected Form 5498 20
Corrective distributions 6
Cost of current life insurance
protection 10
D
Death benefit payments 9
Deemed IRAs 3
Designated Roth account,
contributions 2
Designated Roth account, direct
rollover 4, 5
Designated Roth account,
distributions 9, 10, 14
Direct rollovers 4–6, 8, 10, 12, 13, 16,
17, 21
Disaster relief reporting 19
Disclaimer of an IRA 8
Distributions under EPCRS 7
DVECs 3
E
Eligible rollover distribution 4, 12, 13
Employee contributions, retirement
plan 13, 14
Employer securities, distributions 7, 9,
10, 12, 13
Endowment contracts 2, 21
Excess deferrals, excess contributions,
corrective distributions of 6
F
Failing ADP or ACP test, corrections 7

Federal income tax withholding 12
Form 1099-R 1
Form 5498 17
Form 945 12
G
Guide to Distribution Codes 15–17
I
Inherited IRAs 19, 21
In-plan Roth rollover (IRR) 2, 9, 14
Insurance contracts 1, 13
Involuntary distributions 4, 5
IRA contributions 17
IRA distributions 1, 3, 14, 15
IRA recharacterizations 3, 6, 10, 12, 17,
18, 21
IRA revocation 3, 18
L
Late rollovers 22
Life insurance contract distributions 2
Loans treated as distributions 4, 7
Losses, retirement distributions 7, 10
M
Military death gratuities 20
Military retirement 1
N
Net unrealized appreciation 4, 10, 12, 13
Nonperiodic distributions 12
Nonqualified plan distributions 2
Nonresident aliens 8
P
Pension distributions 1–15
Periodic payments 12
Permissible withdrawals under section
414(w) 8
Postponed contribution 22
Profit-sharing distributions 1–15
Q
QDRO 4, 6, 8
Qualified HSA funding distributions 1

-23-

Qualified plan distributions 1–15
Qualified rollover contributions 5, 21
R
Recharacterized IRA contributions 6, 9,
12, 17
Reportable death benefits 1
Required minimum distribution 18, 22
Retirement payments 1–15
Revocation, IRA 3, 18
RMD 18, 22
RMD amount 22
RMD date 22
Rollovers 4–6, 8–10, 12, 13, 17, 18, 21
Roth IRA contributions 18, 21
Roth IRA conversions 3, 6, 11, 12, 18,
21
Roth IRA distributions 3, 11, 12
S
Section 1035 exchange 2, 6, 9
Section 402(f) notice 5
Section 404(k) dividends 2
SEP contributions 3, 11, 17, 21
SEP distributions 3, 11, 13
Servicemembers' Group Life Insurance
(SGLI) payments 20
SIMPLE contributions 17, 21
SIMPLE distributions 3, 6, 11, 13
State and local information 14
Statements to recipients/participants 9
T
Taxable amount, retirement
distributions 10
Transfers:
Form 1099-R 6
Form 5498 17
U
U.S. Armed Forces, special reporting 19
W
Withholding 12
Federal income tax 12