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to the official IRS form. Do not file copy A downloaded from this website. The official
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about printing these tax forms.

CORRECTED
PAYER’S name, street address, city, state, ZIP code, and telephone no.
OMB No. 1545-0120
Unemployment compensation
1
$
State or local income tax
refunds, credits, or offsets
2
$
PAYER’S federal identification number
RECIPIENT’S identification number
Federal income tax withheld
4
Box 2 amount is for tax year
3
$
Taxable grants
6
RECIPIENT’S name
$
8 Check if box 2 is
trade or business
income
ᮣ
Agriculture payments
7
Street address (including apt. no.)
$
City, state, and ZIP code
Account number (see instructions)
Department of the Treasury - Internal Revenue Service
Form
1099-G
VOID
8686
Do Not Cut or Separate Forms on This Page
—
Do Not Cut or Separate Forms on This Page
Cat. No. 14438M
Form
1099-G
Certain
Government
Payments
5
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the 2011
General
Instructions for
Certain Information
Returns.
ATAA/RTAA payments
$
20
11
Market gain
9
$
State
10a
State identification no.
10b
State income tax withheld
11
$

CORRECTED (if checked)
PAYER’S name, street address, city, state, ZIP code, and telephone no.
Certain
Government
Payments
PAYER’S federal identification number
RECIPIENT’S identification number
RECIPIENT’S name
Street address (including apt. no.)
City, state, and ZIP code
Account number (see instructions)
Department of the Treasury - Internal Revenue Service
Form
1099-G
Copy B
This is important tax
information and is
being furnished to the
Internal Revenue
Service. 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.
(keep for your records)
For Recipient
OMB No. 1545-0120
Unemployment compensation
1
$
State or local income tax
refunds, credits, or offsets
2
$
Federal income tax withheld
4
Box 2 amount is for tax year
$
Taxable grants
6
$
8 If checked, box 2 is
trade or business
income
ᮣ
Agriculture payments
7
$
Form
1099-G
5
ATAA/RTAA payments
$
20
11
Market gain
9
$
State
10a
State identification no.
10b
State income tax withheld
11
3
$

Instructions for Recipient
Account number. May show an account or other unique number the payer
has assigned to distinguish your account.
Box 2. Shows refunds, credits, or offsets of state or local income tax you
received. It may be taxable to you if you deducted the state or local income
tax paid on Schedule A (Form 1040). Even if you did not receive the amount
shown, for example, because it was credited to your state or local estimated
tax, it is still taxable if it was deducted. If you received interest on this amount,
you should receive Form 1099-INT for the interest. However, the payer may
include interest of less than $600 in the blank box next to Box 9 on Form
1099-G. Regardless of whether the interest is reported to you, report it as
interest income on your tax return. See your tax return instructions.
Box 6. Shows taxable grants you received from a federal, state, or local
government.
Box 7. Shows your taxable Department of Agriculture payments. If the payer
shown is anyone other than the Department of Agriculture, it means the payer
has received a payment, as a nominee, that is taxable to you. This may
represent the entire agricultural subsidy payment received on your behalf by
the nominee, or it may be your pro rata share of the original payment. See
Pub. 225 and the Instructions for Schedule F (Form 1040) for information about
where to report this income. Partnerships, see Form 8825 for how to report.
Box 3. Identifies the tax year for which the box 2 refunds, credits, or offsets
shown were made. If there is no entry in this box, the refund is for 2010 taxes.
Box 4. Shows backup withholding or withholding you requested on
unemployment compensation, Commodity Credit Corporation (CCC) loans, or
certain crop disaster payments. Generally, a payer must backup withhold on
certain payments if you did not give your taxpayer identification number to the
payer. See Form W-9 for information on backup withholding. Include this
amount on your income tax return as tax withheld.
Box 8. If this box is checked, the amount in box 2 is attributable to an income
tax that applies exclusively to income from a trade or business and is not a tax
of general application. If taxable, report the amount in box 2 on Schedule C or
F (Form 1040), as appropriate.
Box 5. Shows alternative trade adjustment assistance (ATAA) and/or
reemployment trade adjustment assistance (RTAA) payments you received.
Include on Form 1040 on the “Other income” line. See the Form 1040
instructions.
Box 1. Shows the total unemployment compensation paid to you this year.
Combine the box 1 amounts from all Forms 1099-G and report the total as
income on the unemployment compensation line of your tax return. Except as
explained below, this is your taxable amount. If you are married filing jointly,
each spouse must figure his or her taxable amount separately. If you expect to
receive these benefits in the future, you can ask the payer to withhold federal
income tax from each payment. Or, you can make estimated tax payments.
For details, see Form 1040-ES. If you made contributions to a governmental
unemployment compensation program or to a governmental paid family leave
program and received a payment from that program, the payer must issue a
separate Form 1099-G to report this amount to you. If you itemize deductions,
you may deduct your contributions on Schedule A (Form 1040) as taxes paid.
If you do not itemize, you only need to include in income the amount that is in
excess of your contributions.
Box 9. Shows market gain on CCC loans whether repaid using cash or CCC
certificates. See the Instructions for Schedule F (Form 1040).
Boxes 10a–11. State income tax withheld reporting boxes.

CORRECTED
PAYER’S name, street address, city, state, ZIP code, and telephone no.
Certain
Government
Payments
PAYER’S federal identification number
RECIPIENT’S identification number
RECIPIENT’S name
Street address (including apt. no.)
City, state, and ZIP code
Account number (see instructions)
Department of the Treasury - Internal Revenue Service
Form
1099-G
VOID
Copy C
For Payer
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain Information
Returns.
OMB No. 1545-0120
Unemployment compensation
1
$
State or local income tax
refunds, credits, or offsets
2
$
Federal income tax withheld
4
Box 2 amount is for tax year
$
Taxable grants
6
$
8 Check if box 2 is
trade or business
income
ᮣ
Agriculture payments
7
$
Form
1099-G
5
ATAA/RTAA payments
$
20
11
Market gain
9
$
State
10a
State identification no.
10b
State income tax withheld
11
3
$

Instructions for Payer
General and specific form instructions are provided as
separate products. The products you should use to
complete Form 1099-G are the 2011 General
Instructions for Certain Information Returns and the
2011 Instructions for Form 1099-G. A chart in the
general instructions gives a quick guide to which form
must be filed to report a particular payment. To order
these instructions and additional forms, visit IRS.gov or
call 1-800-TAX-FORM (1-800-829-3676).
Due dates. Furnish Copy B of this form to the
recipient by January 31, 2012.
File Copy A of this form with the IRS by February 28,
2012. If you file electronically, the due date is
April 2, 2012. To file electronically, you must have
software that generates a file according to the
specifications in Pub. 1220, Specifications for Filing
Forms 1097, 1098, 1099, 3921, 3922, 5498, 8935, and
W-2G Electronically. IRS does not provide a fill-in form
option.
Caution: Because paper forms are scanned during
processing, you cannot file with the IRS Forms 1096,
1097, 1098, 1099, 3921, 3922, or 5498 that you print
from the IRS website.
Need help? If you have questions about reporting on
Form 1099-G, call the information reporting customer
service site toll free at 1-866-455-7438 or
304-263-8700 (not toll free). For TTY/TDD equipment,
call 304-579-4827 (not toll free). The hours of operation
are Monday through Friday from 8:30 a.m. to 4:30
p.m., Eastern time.