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Fillable Form 1099-R (2021)

This form is filed 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 orretirement plans, any individual retirement arrangements(IRAs), annuities, pensions, insurance contracts, survivor income benefit plans, permanent and total disability payments under life insurance contracts, charitable gift annuities, etc.

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What is Form 1099-R?

Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., is a form by the Internal Revenue System (IRS) to report distributions from annuities, retirement plans, insurance contracts, pensions, IRAs, or profit-sharing plans. The amounts taxpayer needs to enter in this form are passive income and retirement plans.

The IRS 1099-R Form is one of the several forms in the 1099 series, which includes Form 1099-A, Acquisition or Abandonment of Secured Property, and Form 1099-NEC, Nonemployee Compensation. 1099 forms are used to report several types of income apart from their salaries, such as interest, dividends, or government payments.

You may download a PDF copy of the 1099 R Form on the IRS website. But you may electronically fill it out on PDFRun for your convenience.

How to fill out Form 1099-R?

Form 1099-R has six copies, namely:

  • Copy A - Copy for the Internal Revenue Service Center
  • Copy 1 - Copy for the State, City, or Local Tax Department
  • Copy B - Payer’s copy to be reported on their federal tax return
  • Copy C - Copy for recipient’s records
  • Copy 2 - Payer’s copy to be filed with their state, city, or local tax department, when required
  • Copy D - Payer’s Copy

The payer is required to fill out all the fields with their necessary information. The instructions provided below shall be applicable to all copies.

Payer’s Name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.

Enter the payer’s full legal name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number.

Payer’s TIN

Enter the payer’s Tax Identification Number (TIN).

Recipient’s TIN

Enter the recipient’s Tax Identification Number (TIN).

Recipient’s Name

Enter the recipient’s full legal name.

Street Address (including apt. no.)

Enter the recipient’s street address. If their address has an apartment number, include it in this section.

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

Enter the recipient’s city or town, state or province, country, and ZIP or foreign postal code.

Account Number

Enter the recipient’s account number.

Item 1 - Gross Distribution

Enter your gross distribution for the year.

Item 2a - Taxable Amount

Enter the taxable amount of your gross distribution.

Item 2b

Mark the appropriate box to determine if you determined the taxable amount in the distribution. You may select:

  • Taxable amount not determined
  • Total distribution

If you don’t know the taxable amount of the distribution, mark “taxable amount not determined.” If you made a total distribution of the balance, mark “Total distribution.”

Item 3 - Capital gain

Enter the amount of the distribution allocated to capital gains.

Item 4 - Federal income tax withheld

Enter the federal income tax withheld from your distribution, if any.

Item 5 - Employee contributions/Designated Roth contributions or insurance premiums

Enter the amount of the distribution allocated to employee contributions, designated Roth contributions, or insurance premiums.

Item 6 - Net unrealized appreciation in employer’s securities

Enter the net unrealized appreciation in your employer’s securities.

Item 7 - Distribution code(s)

Enter the distribution code specifying the type of distribution received. The distribution codes are the following:

  • 1 - Early distribution, no known exception
  • 2 - Early distribution, exception applies
  • 3 - Disability
  • 4 - Death
  • 5 - Prohibited transaction
  • 6 - Section 1035 exchange (a tax exchange of life insurance, annuity, qualified long-term care insurance, or endowment contract)
  • 7 - Normal distribution
  • 8 - Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2021.
  • 9 - Cost of current life insurance protection
  • A - May be eligible for 10-year tax option
  • B - Designated Roth account distribution
  • C - Reportable death benefits under section 6050Y
  • D - Annuity payment from nonqualified annuities that may be subject to tax under section 1411
  • E - Distributions under Employee Plans Compliance Resolution System
  • F - Charitable gift annuity
  • G - Direct rollover of a distribution to a qualified plan, a section 403(b) plan, a governmental section 457(b), or an IRA
  • H - Direct rollover of a designated Roth account distribution to a Roth IRA
  • J - Early distribution from a Roth IRA, no known exception (in most cases under age 59%)
  • K - Distribution of traditional IRA assets not having a readily available FMV
  • L - Loans treated as distributors
  • M - Qualified plan loan offset
  • N - Recharacterized IRA contribution made for 2021 and recharacterized in 2021
  • P - Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2020
  • Q - Qualified distribution from a Roth IRA
  • R - Recharacterized IRA contribution made for 2020 and recharacterized in 2021
  • S - Early distribution from a SIMPLE IRA in first two years, no known exception (under age 59%)
  • T - Roth IRA distribution, exception applies
  • U - Dividend distribution from ESOP under section 404(k)
  • W - Charges or payments for purchasing qualified long-term care insurance contracts under combined arrangements

If Code B is in Item 7 and an amount is reported in Item 11, see the instructions for Form 5239, Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts.

The distribution under Code U is not eligible for rollover.

Item 8 - Other

Enter additional information, if any.

Item 9a - Your percentage of total distribution

Enter the percentage of your total distribution.

Item 9b - Total employee contributions

Enter the total employee contributions.

Item 10 - Amount allocable to IRR within 5 years

Enter the amount allocable to IRR within five years.

Item 11 - 1st year of desig. Roth contrib.

Enter the first year you made a contribution to the designated Roth account

Item 12 - FATCA filing requirement

Mark the box if you are reporting to satisfy the FACTA filing requirement. If not, leave it unmarked.

Item 13 - Date of payment

Enter the date of payment for any reportable death benefits under section 6050Y, Returns Relating to Certain Life Insurance Contract Transactions.

Item 14 - State tax withheld

Enter the amount of the state tax withheld.

Item 15 - State/Payer’s state no.

Enter the state or payer’s state number.

Item 16 - State distribution

Enter the amount of the state distribution.

Item 17 - Local tax withheld

Enter the amount of the local tax withheld.

Item 18 - Name of locality

Enter the name of the locality where the local tax was withheld.

Item 19 - Local distribution

Enter the amount of the local distribution.

How to file Form 1099-R?

When completing Form 1099-R IRS, use the 2021 General Instructions for Certain Information Returns and the 2021 Instructions for Forms 1099-R and 5498. You may download these at the IRS website.

File Copy A of the IRS 1099-R Form with the IRS on or before February 28, 2022. But if you want to file the form electronically, you may do so until March 31, 2022.

The IRS does not provide a fill-in option for Copy A. The electronic copy must be filed using software that generates a file per Pub. 1220, Specifications for Electronic Filing of Forms.

Copies B, C, and 2 shall be furnished to the recipient by January 31, 2022.


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