This form contains 140 fields organized into 22 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Account Information
Account number (see instructions) Text
Enter the account number associated with the dividends, as per the instructions provided.
Max length: 38 characters
Account number (see instructions) Text
Enter the account number associated with the dividends and distributions, if applicable. Refer to the instructions for more details. This can be up to 38 characters long.
Max length: 38 characters
Account number (see instructions) Text
Enter the account number associated with the dividends or distributions, as per the instructions.
Max length: 38 characters
Additional Information
Text
Enter any additional information required for the form. This field is typically used for miscellaneous notes or details.
topmostSubform[0].CopyB[0].RghtCol[0].f2_31[0 Text
Enter any additional information or comments related to the dividends or distributions.
topmostSubform[0].CopyB[0].RghtCol[0].f2_32[0 Text
Enter any additional information or comments related to the dividends or distributions.
Capital Gains
2a Total capital gain distr Number
Enter the total amount of capital gain distributions received during the tax year. This includes any distributions from mutual funds or other regulated investment companies.
Number
Enter the amount of undistributed capital gains that are not included in Box 2a. This is typically for amounts that are retained by the fund.
Number
Enter the amount of unrecaptured Section 1250 gain. This is a specific type of capital gain related to real estate.
Number
Enter the amount of Section 1202 gain. This refers to gains from qualified small business stock.
Number
Enter the amount of collectibles gain. This includes gains from the sale of collectibles such as art, antiques, and coins.
Number
Enter the total capital gain distributions paid to the recipient.
Number
Enter the total capital gain distributions. This is the amount reported in Box 2a of the 1099-DIV form.
Number
Enter the unrecaptured section 1250 gain. This is the amount reported in Box 2c of the 1099-DIV form.
Number
Enter the section 1202 gain. This is the amount reported in Box 2d of the 1099-DIV form.
Number
Enter the collectibles (28%) gain. This is the amount reported in Box 2e of the 1099-DIV form.
Number
Enter the total capital gain distributions paid to the recipient.
Distributions
Number
Enter the amount of nondividend distributions. These are distributions that are not paid out of earnings and profits.
9 Number
Enter the cash liquidation distributions received during the tax year. These are distributions received when a corporation is partially or completely liquidated.
Number
Enter the noncash liquidation distributions received during the tax year. These are distributions received in a form other than cash when a corporation is partially or completely liquidated.
Number
Enter the total nondividend distributions. This is the amount reported in Box 3 of the 1099-DIV form.
Number
Enter the cash liquidation distributions. This is the amount reported in Box 8 of the 1099-DIV form.
topmostSubform[0].CopyB[0].RghtCol[0].Box9_ReadOrder[0].f2_23[0 Number
Enter the noncash liquidation distributions. This is the amount reported in Box 9 of the 1099-DIV form.
Dividend Information
topmostSubform[0].CopyA[0].RghtCol[0].f1_9[0 Text
Enter the relevant information as required by the form instructions.
Text
Enter the relevant information as required by the form instructions.
topmostSubform[0].Copy1[0].RghtCol[0].f2_9[0 Number
Enter the amount of ordinary dividends paid to the recipient.
Number
Enter the amount of qualified dividends paid to the recipient.
Number
Enter the amount of nondividend distributions paid to the recipient.
topmostSubform[0].Copy2[0].RghtCol[0].f2_9[0 Number
Enter the amount of ordinary dividends paid to the recipient.
topmostSubform[0].Copy2[0].RghtCol[0].f2_10[0 Number
Enter the amount of qualified dividends paid to the recipient.
Number
Enter the amount of nondividend distributions paid to the recipient.
Dividends
Number
Enter the amount of total ordinary dividends received during the tax year. This includes dividends from stocks and mutual funds.
Number
Enter the amount of qualified dividends. These are dividends that qualify for a lower tax rate.
Number
Enter the amount of Section 199A dividends. These are dividends that may qualify for a deduction under Section 199A.
topmostSubform[0].CopyB[0].RghtCol[0].f2_10[0 Number
Enter the total ordinary dividends received. This is the amount reported in Box 1a of the 1099-DIV form.
Number
Enter the total qualified dividends received. This is the amount reported in Box 1b of the 1099-DIV form.
Number
Enter the exempt-interest dividends. This is the amount reported in Box 10 of the 1099-DIV form.
Dividends and Distributions
Text
Enter the relevant information for Box 12. This field is typically used for reporting specific types of dividends or distributions.
topmostSubform[0].CopyA[0].RghtCol[0].f1_26[0 Text
Provide the necessary details for this field, which is part of the dividend and distribution reporting section.
topmostSubform[0].CopyA[0].RghtCol[0].f1_31[0 Text
Enter the relevant information for this field, which is part of the dividend and distribution reporting section.
topmostSubform[0].CopyA[0].RghtCol[0].f1_32[0 Text
Enter the relevant information for this field, which is part of the dividend and distribution reporting section.
Number
Enter the amount for Box 5 as specified in the form instructions. This field is part of the Copy 1 section for state tax departments.
Number
Enter the amount for Box 7 as specified in the form instructions. This field is part of the Copy 1 section for state tax departments.
9 Cash Number
Enter the cash amount for Box 9 as specified in the form instructions.
Number
Enter the amount for Box 12 as specified in the form instructions. This field is part of the Copy 1 section for state tax departments.
topmostSubform[0].Copy1[0].RghtCol[0].Box15_ReadOrder[0].f2_29[0 Number
Enter the amount for Box 15 as specified in the form instructions. This field is part of the Copy 1 section for state tax departments.
Number
Enter the amount for Box 3 as specified in the form instructions.
Number
Enter the amount for Box 5 as specified in the form instructions.
Number
Enter the amount for Box 7 as specified in the form instructions.
9 Cash Number
Enter the cash amount for Box 9 as specified in the form instructions.
Number
Enter the amount for Box 12 as specified in the form instructions.
Expenses
Number
Enter the amount of investment expenses. These are expenses related to the production of investment income.
Number
Enter the investment expenses. This is the amount reported in Box 5 of the 1099-DIV form.
Foreign Income
Number
Enter the amount of foreign source income related to the dividends.
Foreign Information
8 Foreign country or U.S. possession Text
Enter the name of the foreign country or U.S. possession related to the dividends or distributions.
8 Foreign country or U.S. possession Text
Enter the name of the foreign country or U.S. possession related to the dividends or distributions.
Foreign Tax
Number
Enter the amount of foreign tax paid. This is the amount of tax paid to a foreign country or U.S. possession.
8 Foreign country or U.S. possession Text
Enter the name of the foreign country or U.S. possession where the foreign tax was paid.
Number
Enter the amount of foreign tax paid on the dividends.
Number
Enter the foreign tax paid. This is the amount reported in Box 6 of the 1099-DIV form.
Text
Enter the foreign country or U.S. possession to which the foreign tax was paid. This is the information reported in Box 7 of the 1099-DIV form.
8 Foreign country or U.S. possession Text
Enter the foreign country or U.S. possession related to the foreign tax paid. This is the information reported in Box 8 of the 1099-DIV form.
Number
Enter the amount of foreign tax paid on the dividends reported on this form.
Number
Enter the amount of foreign tax paid on the dividends or distributions.
Form Corrections
topmostSubform[0].Copy1[0].RghtCol[0].TagCorrectingSubform[0].c2_3[0]_1 CheckBox
Check this box if the information provided is a correction to a previously submitted form.
topmostSubform[0].CopyB[0].RghtCol[0].TagCorrectingSubform[0].c2_3[0]_1 CheckBox
Check this box if the information on this form is a correction to a previously filed form.
topmostSubform[0].Copy2[0].CopyHeader[0].c2_1[0]_1 CheckBox
Check this box if the information on this form is a correction to a previously filed form.
topmostSubform[0].Copy2[0].CopyHeader[0].c2_1[1]_2 CheckBox
Check this box if the information on this form is a correction to a previously filed form.
Form Information
topmostSubform[0].CopyA[0].RghtCol[0].TagCorrectingSubform[0].c1_3[0]_1 CheckBox
Check this box if the form is being corrected. This indicates that the information on the form has been updated or corrected.
For calendar year Text
Enter the calendar year for which the dividends and distributions are being reported. This should be a four-digit year.
Max length: 4 characters
topmostSubform[0].CopyB[0].CopyHeader[0].c2_1[0]_2 CheckBox
Check this box if the form is being corrected. Leave it unchecked if it is the original form.
For calendar year Text
Enter the calendar year for which this form is being filed.
Max length: 4 characters
General Information
For calendar year Text
Enter the calendar year for which the dividends and distributions are being reported.
Max length: 4 characters
topmostSubform[0].CopyA[0].CopyHeader[0].c1_1[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
topmostSubform[0].CopyA[0].CopyHeader[0].c1_1[1]_2 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
topmostSubform[0].CopyA[0].LeftCol[0].c1_4[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
For calendar year Text
Enter the calendar year for which the dividends and distributions are being reported. This should be a four-digit year.
Max length: 4 characters
topmostSubform[0].Copy1[0].CopyHeader[0].c2_1[0]_1 CheckBox
Check this box if applicable. This checkbox is part of the header information for Copy 1.
topmostSubform[0].Copy1[0].CopyHeader[0].c2_1[1]_2 CheckBox
Check this box if applicable. This checkbox is part of the header information for Copy 1.
Text
Enter the relevant information as required by the form. This field is part of the Copy 1 section for state tax departments.
Text
Enter the relevant information as required by the form. This field is part of the Copy 1 section for state tax departments.
Text
Enter the relevant information as required by the form. This field is part of the Copy 1 section for state tax departments.
topmostSubform[0].Copy1[0].RghtCol[0].f2_26[0 Text
Enter the relevant information as required by the form. This field is part of the Copy 1 section for state tax departments.
Text
Enter the relevant information for this field as specified in the form instructions.
Text
Enter the relevant information for this field as specified in the form instructions.
Text
Enter the relevant information for this field as specified in the form instructions.
Text
Enter the relevant information for this field as specified in the form instructions.
topmostSubform[0].Copy2[0].RghtCol[0].TagCorrectingSubform[0].c2_3[0]_1 CheckBox
Check this box if applicable as per the form instructions.
Text
Enter the relevant information for this field as specified in the form instructions.
Investment Expenses
Number
Enter the amount of investment expenses related to the dividends.
Number
Enter the amount of investment expenses related to the dividends or distributions.
Liquidation Distributions
Number
Enter the amount of cash liquidation distributions paid to the recipient.
Payer Information
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no Text
Enter the payer's full name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number.
PAYER'S TIN Text
Enter the payer's Taxpayer Identification Number (TIN).
Max length: 11 characters
topmostSubform[0].CopyA[0].LeftCol[0].f1_4[0 Text
Enter the payer's TIN again for verification purposes.
Max length: 11 characters
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no Text
Enter the payer's name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number.
PAYER'S TIN Text
Enter the Taxpayer Identification Number (TIN) of the payer. This is a unique identifier for the entity paying the dividends.
Max length: 11 characters
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no Text
Enter the payer's full name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number.
PAYER'S TIN Text
Enter the payer's Taxpayer Identification Number (TIN). This should be a number up to 11 digits long.
Max length: 11 characters
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no Text
Enter the full name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number of the payer.
PAYER'S TIN Text
Enter the Taxpayer Identification Number (TIN) of the payer. This should be a 9-digit number.
Max length: 11 characters
Recipient Information
RECIPIENT'S name Text
Enter the recipient's full name.
Street address (including apt. no.) Text
Enter the recipient's street address, including apartment number if applicable.
City or town, state or province, country, and ZIP or foreign postal code Text
Enter the recipient's city or town, state or province, country, and ZIP or foreign postal code.
Account number (see instructions) Text
Enter the account number associated with the dividends and distributions, as per the instructions.
Max length: 38 characters
RECIPIENT'S TIN Text
Enter the Taxpayer Identification Number (TIN) of the recipient. This is a unique identifier for the individual or entity receiving the dividends.
Max length: 11 characters
RECIPIENT'S name Text
Enter the full name of the recipient who is receiving the dividends.
Street address (including apt. no.) Text
Enter the street address of the recipient, including apartment number if applicable.
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 recipient's address.
RECIPIENT'S TIN Text
Enter the recipient's Taxpayer Identification Number (TIN). This should be a number up to 11 digits long.
Max length: 11 characters
RECIPIENT'S name Text
Enter the full name of the recipient.
Street address (including apt. no.) Text
Enter the recipient's street address, including apartment number if applicable.
City or town, state or province, country, and ZIP or foreign postal code Text
Enter the recipient's city or town, state or province, country, and ZIP or foreign postal code.
14 State Text
Enter the two-letter postal abbreviation for the state where the recipient resides.
Max length: 2 characters
89 Text
Enter the recipient's state identification number, if applicable.
Max length: 2 characters
RECIPIENT'S TIN Text
Enter the Taxpayer Identification Number (TIN) of the recipient. This should be a 9-digit number.
Max length: 11 characters
RECIPIENT'S name Text
Enter the full name of the recipient.
Street address (including apt. no.) Text
Enter the street address of the recipient, including apartment number if applicable.
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 recipient.
State Information
14 State Text
Enter the two-letter state abbreviation for the state related to the dividend or distribution. This is for Box 14.
Max length: 2 characters
2e Text
Enter the two-letter state abbreviation for the state related to the dividend or distribution. This is for Box 14.
Max length: 2 characters
14 State Text
Enter the two-letter state abbreviation for the state related to the dividends or distributions.
Max length: 2 characters
51 Text
Enter the two-letter state abbreviation for the state related to the dividends or distributions.
Max length: 2 characters
14 State Text
Enter the two-letter state abbreviation for Box 14.
Max length: 2 characters
50 Text
Enter the two-letter state abbreviation for Box 14.
Max length: 2 characters
State Tax Information
topmostSubform[0].CopyA[0].RghtCol[0].Box15_ReadOrder[0].f1_29[0 Text
Provide the necessary details for Box 15, which may relate to state tax information or other specific reporting requirements.
topmostSubform[0].CopyA[0].RghtCol[0].Box15_ReadOrder[0].f1_30[0 Text
Provide the necessary details for Box 15, which may relate to state tax information or other specific reporting requirements.
topmostSubform[0].Copy1[0].RghtCol[0].Box15_ReadOrder[0].f2_30[0 Number
Enter the state tax withheld amount for the recipient. This is typically found in Box 15 of the form.
topmostSubform[0].Copy1[0].RghtCol[0].f2_31[0 Text
Enter the state identification number for the payer. This is typically found in Box 16 of the form.
topmostSubform[0].Copy1[0].RghtCol[0].f2_32[0 Text
Enter the name of the state for which the tax is withheld. This is typically found in Box 17 of the form.
topmostSubform[0].Copy2[0].RghtCol[0].Box15_ReadOrder[0].f2_29[0 Text
Enter the state identification number for the payer. This is used for state tax reporting purposes.
topmostSubform[0].Copy2[0].RghtCol[0].Box15_ReadOrder[0].f2_30[0 Number
Enter the amount of state tax withheld from the dividends. This is the tax amount withheld by the state from the dividends paid to you.
topmostSubform[0].Copy2[0].RghtCol[0].f2_31[0 Text
Enter the name of the state where the tax was withheld. This is required for state tax reporting.
topmostSubform[0].Copy2[0].RghtCol[0].f2_32[0 Text
Enter any additional state-specific information required for tax reporting. This may include special codes or notes relevant to the state tax department.
State Tax Withheld
topmostSubform[0].CopyB[0].RghtCol[0].Box15_ReadOrder[0].f2_29[0 Number
Enter the amount of state tax withheld from the dividends reported on this form.
topmostSubform[0].CopyB[0].RghtCol[0].Box15_ReadOrder[0].f2_30[0 Text
Enter the name of the state where state tax was withheld.
Tax Withheld
2c Number
Enter the amount of federal income tax withheld from the dividends.
Number
Enter the federal income tax withheld. This is the amount reported in Box 4 of the 1099-DIV form.
Number
Enter the amount of federal income tax withheld from the dividends reported on this form.
topmostSubform[0].Copy2[0].RghtCol[0].Box2c_ReadOrder[0].f2_13[0 Number
Enter the amount of federal income tax withheld from the dividends or distributions.