I have not seen one of these forms, but it is probably a substitute Form 1099-MISC.
If it contains the name, address, and Taxpayer Identification Number of the Payer, Your name, address, and Social Security number, and the amount you received as rent, that will be sufficient. Enter the information following the instructions for a Form 1099-MISC and you should see the rental income on Schedule E (Form 1040).
