Form Ct-4804 - Instructions printable pdf download

Form CT-4804

Instructions

Use Form CT-4804, Transmittal of Informational Returns Reported

Checklist for Mailing Forms 1099 and W-2G Informational

on CD, to identify the transmitter of a CD ﬁ le. Complete this

Returns on CD:

form in blue or black ink only. All requested information must be

Label the CD. The external label must identify:

entered on Form CT-4804. Include Form CT-1096, Connecticut

•

1099 or W-2G;

Annual Summary and Transmittal of Information Returns, only if

Connecticut tax was withheld.

•

Calendar year;

•

Transmitter name and FEIN;

and

Block 1: Indicate whether the data in this shipment is an original

or replacement ﬁ le by checking the appropriate box.

•

Contact name and telephone number.

Block 2: Enter the calendar year for which the CD ﬁ les are being

Make a backup of the CD for your ﬁ les in case the package

submitted.

sent to DRS is lost or damaged.

Block 3: Enter the transmitter’s FEIN.

Complete and attach Form CT-4804 for each CD ﬁ le, or use

a computer generated form with the same information. Sign

Block 4: Enter the name of the transmitter. See Declaration

and date the declaration. Keep copies of Form CT-4804 for

Requirements below.

your records.

Block 5:Enter the total number of CDs included in your

Use packaging that will protect the media.

shipment.

Place the following items inside each package:

Block 6: Enter the name and address of the company along with

•

The labeled CD;

the name and title of the person to contact about problem ﬁ les.

Also enter the telephone number.

•

A completed Form CT-4804 and Form CT-4802

(if applicable) or a computer generated facsimile; and

Block 7: Enter the combined total number of payee records being

reported.

•

A completed Form CT-1096 if Connecticut tax is withheld

from non-payroll amounts.

Block 8: Use this section to report information for up to four payers.

If additional space is needed, use Form CT-4802,Transmittal

Mailing Address: Send your CDs in the same package with

of Informational Returns Reported on Compact Disc (CD)

transmittal Forms CT- 4804 and CT- 4802 to:

Continuation.

Department of Revenue Services

Only one type of return should be entered on a payer summary.

State of Connecticut

Types of returns must not be intermingled. Use Form CT- 4802

PO Box 5081

to report more than four payers

Hartford CT 06102-5081

If a PO Box cannot be used, send to:

Declaration Requirements: An agent who is a transmitter, service

bureau, paying agent, or disbursing agent may sign Form CT-4804

Department of Revenue Services

on behalf of the payer (or other person required to ﬁ le), if both

State of Connecticut

conditions below are met:

Attn: Processing II, 15th Floor

1. The agent has the authority to sign the form under an agency

25 Sigourney St Ste 2

agreement (oral, written, or implied) that is valid under state

Hartford CT 06106-5032

law; and

Do not enclose paper Forms 1099-MISC, 1099-R, or W-2G; or

2. The agent signs the form and adds the caption “For: (name of

other notes.

payer or other person required to ﬁ le).”

Forms and Publications

The authorized agent’s signing of the declaration on the payer’s

behalf does not relieve the payer of the responsibility for ﬁ ling a

Forms and publications are available anytime by:

correct, complete, and timely Form CT-4804 with attachments, and

•

Internet: Visit the DRS website at

does not relieve the payer of any penalties for not complying with

to download and print Connecticut tax forms; or

those requirements.

•

Telephone: Call 1-800-382-9463 (Connecticut calls

Substitute Forms CT- 4804 and CT- 4802: DRS encourages

outside the Greater Hartford calling area only) and select

the use of computer-generated substitutes for Forms CT-4804

Option 2 from a touch-tone phone; or call 860-297-4753

and CT-4802. The format must include all information requested

(from anywhere).

on these forms including the declaration. See Declaration

TTY, TDD, and Text Telephone users only may transmit inquiries

Requirements.

anytime by calling 860-297-4911.

Packaging CDs for Mailing: Send the CD with an external

label on each volume (multiple volumes allowed), Form

CT-4804, and Form CT-4802, if applicable, in a single box with

proper packing to prevent damage. It is not necessary to use an

oversized box. Mailers for CDs are available commercially. DRS

is unable to return special containers.

Form CT- 4804 (Rev. 09/08)

Page 2 of 3

Form Ct-4804 - Instructions

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