1099-DIV Dividends and Distributions

Attention:
Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded and printed and used to satisfy the requirement to provide the information to
the recipient.
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forms.

9191

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

1a Total ordinary dividends

OMB No. 1545-0110
Form

$
1b Qualified dividends

1099-DIV

(Rev. January 2022)

Dividends and
Distributions

For calendar year

$

PAYER’S TIN

RECIPIENT’S TIN

RECIPIENT’S name

20

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

2e Section 897 ordinary dividends

2f Section 897 capital gain

$

$

3

Nondividend distributions

4

Section 199A dividends

6

Foreign tax paid

8

$
5
7
City or town, state or province, country, and ZIP or foreign postal code

11 FATCA filing
requirement

2nd TIN not.

Investment expenses

$
Foreign country or U.S. possession

$
9

Account number (see instructions)

$

$

Street address (including apt. no.)

Federal income tax withheld

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

12 Exempt-interest dividends

13 Specified private activity
bond interest dividends

$

$

14 State

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

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

15 State identification no. 16 State tax withheld

$
$
Form 1099-DIV (Rev. 1-2022)

Cat. No. 14415N

Do Not Cut or Separate Forms on This Page

www.irs.gov/Form1099DIV

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

1a Total ordinary dividends

OMB No. 1545-0110
Form

$
1b Qualified dividends

1099-DIV

(Rev. January 2022)

Dividends and
Distributions

For calendar year

$

PAYER’S TIN

RECIPIENT’S TIN

20

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

2e Section 897 ordinary dividends

2f Section 897 capital gain

$
RECIPIENT’S name

3

$
Nondividend distributions

4

Section 199A dividends

6

Foreign tax paid

8

$
5
7
City or town, state or province, country, and ZIP or foreign postal code

Investment expenses

$
Foreign country or U.S. possession

$
9

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

11 FATCA filing 12 Exempt-interest dividends
requirement

$
Account number (see instructions)

Federal income tax withheld

$

$

Street address (including apt. no.)

Copy 1
For State Tax
Department

14 State

13 Specified private activity
bond interest dividends

$
15 State identification no. 16 State tax withheld

$
$
Form 1099-DIV (Rev. 1-2022)

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

1a Total ordinary dividends

OMB No. 1545-0110
Form

$
1b Qualified dividends

1099-DIV

(Rev. January 2022)

Dividends and
Distributions

For calendar year

$

PAYER’S TIN

RECIPIENT’S TIN

20

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

2e Section 897 ordinary dividends

2f Section 897 capital gain

$
RECIPIENT’S name

3

$
Nondividend distributions

$
5
7
City or town, state or province, country, and ZIP or foreign postal code

Federal income tax withheld

Section 199A dividends

6

Foreign tax paid

8

Investment expenses

$
Foreign country or U.S. possession

$
9

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

11 FATCA filing 12 Exempt-interest dividends
requirement

$
Account number (see instructions)

4

$

$

Street address (including apt. no.)

Copy B
For Recipient

13 Specified private activity
bond interest dividends

This is important tax
information and is
being furnished to
the IRS. If you are
required to file a
return, a negligence
penalty or other
sanction may be
imposed on you if
this income is taxable
and the IRS
determines that it has
not been reported.

$

14 State

15 State identification no. 16 State tax withheld

$
$
Form 1099-DIV (Rev. 1-2022)

(keep for your records)

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Recipient’s taxpayer identification number (TIN). For your protection, this
form may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN).
However, the issuer has reported your complete TIN to the IRS.
Account number. May show an account or other unique number the payer
assigned to distinguish your account.
Box 1a. Shows total ordinary dividends that are taxable. Include this amount on
the “Ordinary dividends” line of Form 1040 or 1040-SR. Also report it on
Schedule B (Form 1040), if required.
Box 1b. Shows the portion of the amount in box 1a that may be eligible for
reduced capital gains rates. See the Instructions for Form 1040 for how to
determine this amount and where to report.
The amount shown may be dividends a corporation paid directly to you as a
participant (or beneficiary of a participant) in an employee stock ownership plan
(ESOP). Report it as a dividend on your Form 1040 or 1040-SR but treat it as a
plan distribution, not as investment income, for any other purpose.
Box 2a. Shows total capital gain distributions from a regulated investment
company (RIC) or real estate investment trust (REIT). See How To Report in the
Instructions for Schedule D (Form 1040). But, if no amount is shown in boxes 2b,
2c, 2d, and 2f and your only capital gains and losses are capital gain distributions,
you may be able to report the amounts shown in box 2a on your Form 1040 or
1040-SR rather than Schedule D. See the Instructions for Form 1040.
Box 2b. Shows the portion of the amount in box 2a that is unrecaptured section
1250 gain from certain depreciable real property. See the Unrecaptured Section
1250 Gain Worksheet in the Instructions for Schedule D (Form 1040).
Box 2c. Shows the portion of the amount in box 2a that is section 1202 gain
from certain small business stock that may be subject to an exclusion. See the
Schedule D (Form 1040) instructions.
Box 2d. Shows the portion of the amount in box 2a that is 28% rate gain from
sales or exchanges of collectibles. If required, use this amount when completing
the 28% Rate Gain Worksheet in the Instructions for Schedule D (Form 1040).
Box 2e. Shows the portion of the amount in box 1a that is section 897 gain
attributable to disposition of U.S. real property interests (USRPI).
Box 2f. Shows the portion of the amount in box 2a that is section 897 gain
attributable to disposition of USRPI.
Note: Boxes 2e and 2f apply only to foreign persons and entities whose income
maintains its character when passed through or distributed to its direct or

indirect foreign owners or beneficiaries. It is generally treated as effectively
connected to a trade or business within the United States. See the instructions
for your tax return.
Box 3. Shows a return of capital. To the extent of your cost (or other basis) in
the stock, the distribution reduces your basis and is not taxable. Any amount
received in excess of your basis is taxable to you as capital gain. See Pub. 550.
Box 4. Shows backup withholding. A payer must backup withhold on certain
payments if you did not give your TIN to the payer. See Form W-9 for
information on backup withholding. Include this amount on your income tax
return as tax withheld.
Box 5. Shows the portion of the amount in box 1a that may be eligible for the
20% qualified business income deduction under section 199A. See the
instructions for Form 8995 and Form 8995-A.
Box 6. Shows your share of expenses of a nonpublicly offered RIC, generally a
nonpublicly offered mutual fund. This amount is included in box 1a.
Box 7. Shows the foreign tax that you may be able to claim as a deduction or a
credit on Form 1040 or 1040-SR. See the Instructions for Form 1040.
Box 8. This box should be left blank if a RIC reported the foreign tax shown in
box 7.
Boxes 9 and 10. Show cash and noncash liquidation distributions.
Box 11. If the FATCA filing requirement box is checked, the payer is reporting
on this Form 1099 to satisfy its account reporting requirement under chapter 4
of the Internal Revenue Code. You may also have a filing requirement. See the
Instructions for Form 8938.
Box 12. Shows exempt-interest dividends from a mutual fund or other RIC paid
to you during the calendar year. See the Instructions for Form 1040 for where to
report. This amount may be subject to backup withholding. See Box 4 above.
Box 13. Shows exempt-interest dividends subject to the alternative minimum
tax. This amount is included in box 12. See the Instructions for Form 6251.
Boxes 14–16. State income tax withheld reporting boxes.
Nominees. If this form includes amounts belonging to another person, you are
considered a nominee recipient. You must file Form 1099-DIV (with a Form
1096) with the IRS for each of the other owners to show their share of the
income, and you must furnish a Form 1099-DIV to each. A spouse is not
required to file a nominee return to show amounts owned by the other spouse.
See the current General Instructions for Certain Information Returns.

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

1a Total ordinary dividends

OMB No. 1545-0110
Form

$
1b Qualified dividends

1099-DIV

(Rev. January 2022)

Dividends and
Distributions

For calendar year

$

PAYER’S TIN

RECIPIENT’S TIN

20

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

2e Section 897 ordinary dividends

2f Section 897 capital gain

$
RECIPIENT’S name

3

$
Nondividend distributions

4

Section 199A dividends

6

Foreign tax paid

8

$
5
7
City or town, state or province, country, and ZIP or foreign postal code

Federal income tax withheld
Investment expenses

$
Foreign country or U.S. possession

$
9

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

11 FATCA filing 12 Exempt-interest dividends
requirement

$
Account number (see instructions)

To be filed with
recipient’s state
income tax return,
when required.

$

$

Street address (including apt. no.)

Copy 2

14 State

13 Specified private activity
bond interest dividends

$
15 State identification no. 16 State tax withheld

$
$
Form 1099-DIV (Rev. 1-2022)

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

1a Total ordinary dividends

OMB No. 1545-0110
Form

$
1b Qualified dividends

1099-DIV

(Rev. January 2022)

Dividends and
Distributions

For calendar year

$

PAYER’S TIN

RECIPIENT’S TIN

20

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

2e Section 897 ordinary dividends

2f Section 897 capital gain

$
RECIPIENT’S name

3

$
Nondividend distributions

4

Section 199A dividends

6

Foreign tax paid

8

$
5
7
City or town, state or province, country, and ZIP or foreign postal code

$
Foreign country or U.S. possession

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

11 FATCA filing 12 Exempt-interest dividends
requirement

$
2nd TIN not.

Investment expenses

$
9

Account number (see instructions)

Federal income tax withheld

$

$

Street address (including apt. no.)

Copy C
For Payer

14 State

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

13 Specified private activity
bond interest dividends

$
15 State identification no. 16 State tax withheld

$
$
Form 1099-DIV (Rev. 1-2022)

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

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

Foreign dividend recipient. If the recipient of the
dividend is a nonresident alien, you may have to
withhold federal income tax and file Form 1042-S. See
the Instructions for Form 1042-S and Pub. 515.
Need help? If you have questions about reporting on
Form 1099-DIV, call the information reporting customer
service site toll free at 866-455-7438 or 304-263-8700
(not toll free). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).