6174 6172-1 M456174
UI Support & Customer Service
TEXAS WORKFORCE COMMISSION
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320101310061740101
PO BOX 149346
AUSTIN TX 78714-9346
STATEMENT FOR RECIPIENTS OF CERTAIN
GOVERNMENT PAYMENTS (FORM 1099-G)
JAMES R COCHRAN
226 HARTFORD DR
CONROE TX 77303-1804
*773031804269*
All dates are shown in
month-day-year order.
Social Security Number: XXX-XX-7048
INSTRUCTIONS FOR FORM 1099-G
The Texas Workforce Commission (TWC) has reported payments for unemployment benefits to the
Internal Revenue Service (IRS). These benefits may be taxable. If you requested, we withheld tax from
your unemployment benefits.
The amount in Box 1 shows the total amount of unemployment benefits TWC paid you during the period
01-01-20 to 12-31-20 .
* TWC determines the amount by the date we paid the benefits, not by the dates covered on
individual payment requests.
* The amount includes any overpaid benefits you repaid to TWC. TWC must report to the IRS the
full amount we paid you, even if you repaid benefits. If you repaid some or all of an overpayment
during the tax year, subtract the amount you paid back from the amount you are required to report.
* For more information on reporting unemployment benefits on your federal income tax return, see
the IRS instructions for completing your return, or consult your local IRS office or tax professional.
For recipients of Alternative (or Reemployment) Trade Adjustment Assistance for Older Workers Program
(ATAA/RTAA):
* The amount in Box 5 shows the total amount of benefits paid under the ATAA/RTAA program
during the period shown above. See the Other Income section in the IRS instructions for how to
report this amount.
You can view a history of your payments on Claim and Payment Status at ui.texasworkforce.org.
PAYER'S name, address, ZIP, Federal ID number 1. Unemployment compensation OMB no. 1545-0120
$16,693.00 2020 Statement for
2. State or local income tax Recipients of
TEXAS WORKFORCE COMMISSION refunds, credits, or offsets
PO BOX 149137 Certain
AUSTIN TX 78714-9137 Government
Payments
PAYER's Federal ID number RECIPIENT's ID number 3. Box 2 amount is for tax year 4. Federal income tax withheld
Copy B
74-2764775 XXX-XX-7048 $516.00 For Recipient
RECIPIENT's name, address and ZIP code 5. ATAA Payments 6. Taxable grants
This is important tax
$0.00 information and is being
furnished to the IRS. If
7. Agriculture payments 8. The amount in Box 2 applies to you are required to file a
income from a trade or business return, a negligence
penalty or other sanction
may be imposed on you if
JAMES R COCHRAN this income is taxable and
226 HARTFORD DR DO NOT MAIL THIS FORM TO THE I.R.S. the IRS determines it has
CONROE TX 77303-1804 not been reported.
Form 1099-G Department of Treasury-Internal Revenue Service
BP510E 11/08/10
