Federal Taxable Distributions Received From Cooperatives

Taxable Distributions Received From Cooperatives
Form 1099-PATR (Rev. January 2023)
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
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9797

VOID

CORRECTED

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

1 Patronage dividends

OMB No. 1545-0118

$

2 Nonpatronage distributions Form

$
3 Per-unit retain allocations

(Rev. January 2023)
For calendar year

20

$
PAYER’S TIN

RECIPIENT’S TIN

4 Federal income tax withheld

$
6 Section 199A(g) deduction

RECIPIENT’S name

$

1099-PATR

Taxable
Distributions
Received From
Cooperatives

5 Redeemed nonqualified notices

$
7 Qualified payments
(Section 199A(b)(7))

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

$

For Privacy Act
and Paperwork
$
$
Reduction Act
City or town, state or province, country, and ZIP or foreign postal code
10 Investment credit
11 Work opportunity credit
Notice, see the
current General
$
$
Instructions for
Account number (see instructions)
2nd TIN not. 12 Other credits and deductions
13 Specified Coop
Certain Information
Returns.
$
8 Section 199A(a) qual. items

Street address (including apt. no.)

Form 1099-PATR (Rev. 1-2023)

Cat. No. 14435F

www.irs.gov/Form1099PATR

9 Section 199A(a) SSTB items

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

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

OMB No. 1545-0118

1 Patronage dividends

$

2 Nonpatronage distributions Form

$

(Rev. January 2023)

3 Per-unit retain allocations

For calendar year

20

$
PAYER’S TIN

RECIPIENT’S TIN

4 Federal income tax withheld

$

6 Section 199A(g) deduction

$

8 Section 199A(a) qual. items

9 Section 199A(a) SSTB items

$

$

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

10 Investment credit

11 Work opportunity credit

$

$

Account number (see instructions)

12 Other credits and deductions

$
Form 1099-PATR (Rev. 1-2023)

(keep for your records)

www.irs.gov/Form1099PATR

Copy B
For Recipient

7 Qualified payments
(Section 199A(b)(7))

$
Street address (including apt. no.)

Taxable
Distributions
Received From
Cooperatives

5 Redeemed nonqualified notices

$
RECIPIENT’S name

1099-PATR

13 Specified Coop

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.

Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Distributions you received from a cooperative may be includible in your income.
Generally, if you are an individual, report any amounts shown in boxes 1, 2, 3, and 5
as ordinary income, unless nontaxable, on your income tax return. You must report
any redemptions in boxes 2 and 5 as ordinary income to the extent of the stated
dollar value because they were not taxable when issued to you. Amounts shown in
boxes 7, 8, and 9 are information needed to compute your section 199A(a)
deduction. See the instructions for Form 8995 or 8995-A for more information.
Recipient’s taxpayer identification number (TIN). For your protection, this
form may show only the last four digits of your TIN. 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 1. Shows patronage dividends paid to you during the year in cash, qualified
written notices of allocation (at stated dollar value), or other property (not including
nonqualified allocations). Any dividends paid on (1) property bought for personal
use or (2) capital assets or depreciable property used in your business are not
taxable. However, if (2) applies, reduce the basis of the assets by this amount.
Box 2. Shows nonpatronage distributions paid to you during the year in cash,
qualified written notices of allocation, or other property, and amounts you
received in redemption of nonqualified written notices of allocation from
nonpatronage sources.
Box 3. Shows patronage per-unit retain allocations paid to you during the year
in cash, qualified per-unit retain certificates, or other property.
Box 4. Shows backup withholding. Generally, a payer must backup withhold if
you didn’t furnish your TIN. See Form W-9 and Pub. 505 for more information.
Report this amount on your income tax return as tax withheld.
Box 5. Shows amounts you received when you redeemed nonqualified written notices
of allocation and nonqualified per-unit retain allocations from patronage sources.

Box 6. Shows your share of the cooperative’s section 199A(g) deduction passed
through to you. The amount must have been designated in a written notice sent
to you from the cooperative during the section 1382(d) payment period. To claim
the deduction, you must not be a C corporation.
Box 7. Shows the amount of qualified payments paid to you on which the
cooperative computed its section 199A(g) deduction. If there is an amount in
this box and the amount is related to a trade or business for which you are
claiming a section 199A(a) deduction, you are required to compute a reduction
to your deduction per section 199A(b)(7).
Box 8. Shows items received and reported in boxes 1, 2, 3, and 5 that may
qualify as qualified items from trades or businesses that are not a specified
service trade or business (SSTB) for purposes of the section 199A(a) deduction.
Items relating to SSTBs are reported separately in box 9.
Box 9. Shows amounts received and reported in boxes 1, 2, 3, and 5 from an
SSTB that may qualify as qualified items for purposes of the section 199A(a)
deduction. Use Form 8995 or 8995-A to determine your section 199A(a) deduction.
Box 10. Shows investment credits passed through to you by the cooperative.
Use Form 3468 to compute your allowable credit.
Box 11. Shows work opportunity credits passed through to you. Use Form 5884
or 3800 to compute your allowable credit.
Box 12. Shows other credits and deductions passed through to you. For information
on how to report credits, see the instructions for the specific credit form.
Box 13. If this box is checked, the information reported to you is from a specified
agricultural or horticultural cooperative, as defined in section 199A(g)(4)(A).
Future developments. For the latest information about developments related to
Form 1099-PATR and its instructions, such as legislation enacted after they
were published, go to www.irs.gov/Form1099PATR.
Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost
online federal tax preparation, e-filing, and direct deposit or payment options.

VOID

CORRECTED

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

1 Patronage dividends

OMB No. 1545-0118

$

2 Nonpatronage distributions Form

$
3 Per-unit retain allocations

(Rev. January 2023)
For calendar year

20

$
PAYER’S TIN

4 Federal income tax withheld

RECIPIENT’S TIN

$
6 Section 199A(g) deduction

RECIPIENT’S name

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)

Taxable
Distributions
Received From
Cooperatives

5 Redeemed nonqualified notices

$

Copy C
For Payer

7 Qualified payments
(Section 199A(b)(7))

For Privacy Act
and Paperwork
Reduction Act
8 Section 199A(a) qual. items 9 Section 199A(a) SSTB items
Notice, see the
$
$
current General
10 Investment credit
11 Work opportunity credit
Instructions for
Certain Information
$
$
Returns.

$

Street address (including apt. no.)

1099-PATR

2nd TIN not. 12 Other credits and deductions

$

13 Specified Coop

$
Form 1099-PATR (Rev. 1-2023)

www.irs.gov/Form1099PATR

Department of the Treasury - Internal Revenue Service

Instructions for Payer
To complete Form 1099-PATR, use:
• The current General Instructions for Certain Information
Returns, and
• The current Instructions for Form 1099-PATR.
To get and 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 requesting filing or furnishing
extensions, see the current General Instructions for Certain
Information Returns.
Foreign recipient. If the recipient 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-PATR, call the Technical Services Operation (TSO)
toll free at 866-455-7438 or 304-263-8700 (not toll free).
Deaf or hard of hearing customers may call any of our
toll-free numbers using their choice of relay service.