This form contains 50 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Information
Text
Enter any additional information or notes related to the cancellation of the debt, if applicable.
Text
Enter any other relevant information or notes that pertain to the cancellation of the debt, if necessary.
Creditor Information
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no Text
Enter the creditor's full name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number.
CREDITOR'S TIN Text
Enter the creditor's Taxpayer Identification Number (TIN).
Max length: 11 characters
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no Text
Enter the creditor's full name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number.
CREDITOR'S TIN Text
Enter the creditor's Taxpayer Identification Number (TIN). This should be a 9-digit number.
Max length: 11 characters
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no Text
Enter the creditor's full name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number.
CREDITOR'S TIN Text
Enter the creditor's Taxpayer Identification Number (TIN). This should be a number up to 11 digits long.
Max length: 11 characters
Account number (see instructions) Text
Enter the account number associated with the debt that has been canceled. Refer to the instructions for guidance on how to find and enter this number.
Debt Details
topmostSubform[0].CopyA[0].RightCol[0].c1_2[0]_1 CheckBox
Check this box if the cancellation of debt is due to a bankruptcy proceeding.
topmostSubform[0].CopyA[0].RightCol[0].f1_13[0 Number
Enter the amount of debt canceled. This is the principal amount of the debt that has been forgiven.
Text
Enter any additional information related to the debt cancellation that may be required.
topmostSubform[0].CopyB[0].c2_1[0]_2 CheckBox
Check this box if the debtor was personally liable for repayment of the debt.
Account number (see instructions) Text
Enter the account number associated with the debt. Refer to the instructions for more details.
1 Date of identifiable event Date
Enter the date of the identifiable event that led to the cancellation of the debt. Use the format MM/DD/YYYY.
Text
Enter any additional information related to the identifiable event that may be required.
1 Date of identifiable event Date
Provide the date when the identifiable event occurred that led to the cancellation of the debt. This is typically the date when the debt was discharged.
Number
Enter the amount of debt that has been canceled. This should be the total amount that was discharged.
4 Debt description Text
Provide a description of the debt that has been canceled. This could include the type of debt or any relevant details that identify it.
Debt Information
Account number (see instructions) Text
Enter the account number associated with the canceled debt, as per the instructions.
4 Debt description Text
Provide a description of the debt that was canceled.
4 Debt description Text
Enter a description of the debt that has been canceled. This should include details that clearly identify the debt.
6 Identifiable event code Text
Enter the identifiable event code that corresponds to the reason for the debt cancellation. Refer to the IRS instructions for the correct code.
Debtor Information
DEBTOR'S TIN Text
Enter the debtor's Taxpayer Identification Number (TIN).
Max length: 11 characters
DEBTOR'S name Text
Enter the debtor's full name.
Street address (including apt. no.) Text
Enter the debtor's street address, including apartment number if applicable.
City or town, state or province, country, and ZIP or foreign postal code Text
Enter the debtor's city or town, state or province, country, and ZIP or foreign postal code.
DEBTOR'S TIN Text
Enter the debtor's Taxpayer Identification Number (TIN). This should be a 9-digit number.
Max length: 11 characters
DEBTOR'S name Text
Enter the full name of the debtor.
Street address (including apt. no.) Text
Enter the debtor's street address, including apartment number if applicable.
f120 City or town, state or province, country, and ZIP or foreign postal code Text
Enter the debtor's city or town, state or province, country, and ZIP or foreign postal code.
DEBTOR'S TIN Text
Enter the debtor's Taxpayer Identification Number (TIN). This should be a number up to 11 digits long.
Max length: 11 characters
DEBTOR'S name Text
Enter the full name of the debtor whose debt has been canceled.
Street address (including apt. no.) Text
Enter the street address of the debtor, including apartment number if applicable.
5bef City or town, state or province, country, and ZIP or foreign postal code Text
Enter the city or town, state or province, country, and ZIP or foreign postal code of the debtor.
Event Details
topmostSubform[0].CopyC[0].RightCol[0].c2_2[0]_1 CheckBox
Check this box if the debt was canceled due to a bankruptcy proceeding. Leave it unchecked if not applicable.
6 Identifiable event code Text
Enter the code that corresponds to the identifiable event that led to the cancellation of the debt. Refer to the instructions for the list of codes.
Event Information
topmostSubform[0].CopyA[0].c1_1[0]_1 CheckBox
Check this box if the identifiable event is a discharge of indebtedness in a Title 11 bankruptcy case.
topmostSubform[0].CopyA[0].c1_1[1]_2 CheckBox
Check this box if the identifiable event is a discharge of indebtedness while the debtor was insolvent.
1 Date of identifiable event Date
Enter the date of the identifiable event that led to the cancellation of the debt.
Form Information
20 Text
Enter the last two digits of the calendar year for which the debt was canceled.
Max length: 2 characters
20 Text
Enter the calendar year in which the debt was canceled. Use a two-digit format (e.g., '20' for 2020).
Max length: 2 characters
20 Text
Enter the last two digits of the calendar year for which the debt was canceled.
Max length: 2 characters
General Information
Text
This field is likely for additional information or notes related to the form. Please refer to the form instructions for specific details.
topmostSubform[0].CopyB[0].RightCol[0].c2_2[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions to determine when this checkbox should be selected.
Text
This field is likely for additional information or notes related to the form. Please refer to the form instructions for specific details.
topmostSubform[0].CopyC[0].c2_1[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions to determine when this checkbox should be selected.
topmostSubform[0].CopyC[0].c2_1[1]_2 CheckBox
Check this box if applicable. Refer to the form instructions to determine when this checkbox should be selected.
Unlabeled Field
Text
This field is not labeled. Please refer to the form instructions for its intended use.
Text
This field is not labeled. Please refer to the form instructions for its intended use.