This form contains 192 fields organized into 23 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 distribution, if applicable. Refer to the instructions for more details.
Account number (see instructions)	Text	Enter the account number associated with this distribution, as per the instructions.
Account number (see instructions)	Text	Enter the account number associated with the distribution, as per the instructions provided.
Additional Information
	Text	Provide the relevant information as required by the form instructions for this field.
topmostSubform[0].CopyA[0].f1_09[0	Text	Provide the relevant information as required by the form instructions for this field.
topmostSubform[0].CopyA[0].Box14_ReadOrder[0].f1_22[0	Text	Enter any additional information or special conditions related to the distribution.
topmostSubform[0].CopyA[0].f1_26[0	Text	Enter any additional information required for the form, possibly related to state or local tax details.
topmostSubform[0].CopyA[0].f1_27[0	Text	Enter any additional information required for the form, possibly related to state or local tax details.
	Text	Enter any additional information required for the form, possibly related to state or local tax details.
topmostSubform[0].CopyA[0].f1_33[0	Text	Enter any additional information required for the form, possibly related to state or local tax details.
	Text	Enter any other information or amounts related to the distribution that are not covered by other fields.
8 Other	Text	Enter any other relevant information related to the distribution that does not fit into the other specified categories.
topmostSubform[0].Copy1[0].f2_16[0	Text	Provide any additional information or notes related to the distribution, if applicable.
topmostSubform[0].Copy1[0].f2_18[0	Text	Provide any additional information or notes related to the distribution, if applicable.
topmostSubform[0].Copy1[0].Box14_ReadOrder[0].f2_22[0	Text	Provide any additional information or notes related to the distribution, if applicable.
topmostSubform[0].Copy1[0].Box14_ReadOrder[0].f2_23[0	Text	Provide any additional information or notes related to the distribution, if applicable.
	Text	Enter any additional information related to the distribution that may be required.
	Text	Enter any additional information related to the distribution that may be required.
topmostSubform[0].CopyB[0].f2_27[0	Text	Enter any additional information related to the distribution that may be required.
topmostSubform[0].CopyB[0].f2_32[0	Text	Provide any additional information required for this section.
topmostSubform[0].CopyB[0].f2_33[0	Text	Provide any additional information required for this section.
	Text	Enter any additional information or notes related to the distribution that may be required.
Checkbox Options
topmostSubform[0].CopyB[0].c2_2[0]_1	CheckBox	Check this box if applicable, as per the form instructions.
topmostSubform[0].CopyB[0].c2_3[0]_1	CheckBox	Check this box if applicable, as per the form instructions.
topmostSubform[0].CopyB[0].Box7_ReadOrder[0].c2_4[0]_1	CheckBox	Check this box if applicable, as per the form instructions.
Distribution Amounts
	Number	Enter the gross distribution amount. This is the total amount distributed before any deductions or taxes.
Distribution Details
Capital box	Number	Enter the capital amount related to the distribution, if applicable.
6	Number	Enter the net unrealized appreciation (NUA) in employer's securities. This is the portion of the distribution that is not taxable until the securities are sold.
7 Distribution code(s)	Text	Enter the distribution code(s) that describe the type of distribution made. Refer to the IRS instructions for the appropriate codes.
topmostSubform[0].CopyA[0].Box7_ReadOrder[0].c1_4[0]_1	CheckBox	Check this box if the distribution is a total distribution that closed out the account.
topmostSubform[0].CopyA[0].f1_16[0	Number	Enter the gross distribution amount. This is the total amount distributed before any deductions or taxes.
topmostSubform[0].CopyA[0].Box9a_ReadOrder[0].f1_17[0	Number	Enter the taxable amount of the distribution. This is the portion of the distribution that is subject to income tax.
	Number	Enter the gross distribution amount. This is the total amount distributed before any deductions or taxes.
	Number	Enter the taxable amount of the distribution. This is the portion of the gross distribution that is subject to tax.
topmostSubform[0].Copy1[0].c2_2[0]_1	CheckBox	Check this box if the distribution is a total distribution that closed out the account.
topmostSubform[0].Copy1[0].c2_3[0]_1	CheckBox	Check this box if the distribution is a direct rollover to a qualified plan or IRA.
	Number	Enter the amount of capital gain included in the distribution, if applicable.
	Number	Enter the amount of employee contributions or insurance premiums, if applicable.
7 Distribution code(s)	Text	Enter the distribution code(s) that apply to the distribution reported on this form. These codes indicate the type of distribution and any special tax treatment.
topmostSubform[0].Copy1[0].Box7_ReadOrder[0].c2_4[0]_1	CheckBox	Check this box if the distribution is subject to special tax treatment. Refer to the IRS instructions for more details.
topmostSubform[0].Copy1[0].Box9a_ReadOrder[0].f2_17[0	Number	Enter the percentage of the total distribution that is a capital gain, if applicable.
topmostSubform[0].Copy1[0].Box12-13_ReadOrder[0].c2_5[0]_1	CheckBox	Check this box if the distribution is subject to special tax treatment. Refer to the IRS instructions for more details.
to IRR 11 1st year Roth	Date	Enter the first year of the Roth IRA conversion, if applicable.
7 Distribution code(s)	Text	Enter the distribution code(s) that apply to this distribution.
topmostSubform[0].CopyB[0].Box9a_ReadOrder[0].f2_17[0	Number	Enter the percentage of total distribution that is a capital gain. This is typically used for reporting capital gain distributions.
topmostSubform[0].CopyC[0].c2_2[0]_1	CheckBox	Check this box if the distribution is a total distribution that closed out your account.
topmostSubform[0].CopyC[0].c2_3[0]_1	CheckBox	Check this box if the distribution is a direct rollover to a qualified plan or IRA.
7 Distribution code(s)	Text	Enter the distribution code(s) that describe the type of distribution. Refer to the IRS instructions for the appropriate codes.
topmostSubform[0].CopyC[0].Box7_ReadOrder[0].c2_4[0]_1	CheckBox	Check this box if the distribution is subject to early distribution penalty.
topmostSubform[0].CopyC[0].Box9a_ReadOrder[0].f2_17[0	Number	Enter the percentage of the total distribution that is a capital gain. This is applicable if part of the distribution is considered a capital gain.
topmostSubform[0].CopyC[0].Box14_ReadOrder[0].f2_22[0	Text	Enter the relevant information for Box 14, which may include specific distribution details or codes as per the form instructions.
topmostSubform[0].CopyC[0].Box14_ReadOrder[0].f2_23[0	Text	Enter additional information for Box 14, which may include specific distribution details or codes as per the form instructions.
topmostSubform[0].CopyC[0].Box17_ReadOrder[0].f2_28[0	Text	Enter the relevant information for Box 17, which may include specific distribution details or codes as per the form instructions.
18 af56	Text	Enter the relevant information for Box 18, which may include specific distribution details or codes as per the form instructions.
18	Text	Enter the relevant information for Box 18, which may include specific distribution details or codes as per the form instructions.
18 af56 6e39	Text	Enter the relevant information for Box 18, which may include specific distribution details or codes as per the form instructions.
	Number	Enter the amount for Box 3, which typically represents the capital gain portion of a distribution.
topmostSubform[0].Copy2[0].Box5_ReadOrder[0].f2_12[0	Number	Enter the amount for Box 5, which is the employee contributions or insurance premiums.
topmostSubform[0].Copy2[0].f2_13[0	Number	Enter the amount for Box 6, which is the net unrealized appreciation in employer's securities.
7 Distribution code(s)	Text	Enter the distribution code(s) that apply to the distribution. These codes explain the type of distribution received.
topmostSubform[0].Copy2[0].Box7_ReadOrder[0].c2_4[0]_1	CheckBox	Check this box if the distribution is a total distribution that closed out the account.
topmostSubform[0].Copy2[0].f2_15[0	Number	Enter the amount for Box 8, which is the other income related to the distribution.
topmostSubform[0].Copy2[0].f2_16[0	Number	Enter the amount for Box 9b, which is the total employee contributions.
topmostSubform[0].Copy2[0].Box9a_ReadOrder[0].f2_17[0	Number	Enter the percentage for Box 9a, which is the percentage of total distribution.
topmostSubform[0].Copy2[0].f2_18[0	Number	Enter the amount for Box 10, which is the amount allocable to IRR within 5 years.
	Number	Enter the amount for Box 10, which is the amount allocable to IRR within 5 years.
Distribution Information
topmostSubform[0].CopyB[0].c2_1[0]_2	CheckBox	Check this box if the distribution is a total distribution. This indicates that the entire account balance was distributed.
Distribution Status
topmostSubform[0].Copy2[0].c2_1[0]_2	CheckBox	Check this box if applicable to indicate a specific condition or status related to the distribution on Copy 2 of the form.
topmostSubform[0].Copy2[0].c2_2[0]_1	CheckBox	Check this box if applicable to indicate a specific condition or status related to the distribution on Copy 2 of the form.
topmostSubform[0].Copy2[0].c2_3[0]_1	CheckBox	Check this box if applicable to indicate a specific condition or status related to the distribution on Copy 2 of the form.
Distribution Type
topmostSubform[0].CopyB[0].Box12-13_ReadOrder[0].c2_5[0]_1	CheckBox	Check this box if the distribution is a total distribution that closed out the account.
Financial Details
	Number	Enter the amount for Box 10, which typically relates to the gross distribution amount or other specific financial details as per the form instructions.
topmostSubform[0].CopyC[0].f2_26[0	Text	Enter the relevant information for this field, which may relate to specific financial or tax details as per the form instructions.
topmostSubform[0].CopyC[0].f2_27[0	Text	Enter the relevant information for this field, which may relate to specific financial or tax details as per the form instructions.
Form Options
topmostSubform[0].CopyA[0].c1_1[0]_1	CheckBox	Indicate whether this checkbox is applicable for the specific condition it represents on Copy A of the form.
topmostSubform[0].CopyA[0].c1_1[1]_2	CheckBox	Indicate whether this checkbox is applicable for the specific condition it represents on Copy A of the form.
topmostSubform[0].CopyA[0].c1_2[0]_1	CheckBox	Indicate whether this checkbox is applicable for the specific condition it represents on Copy A of the form.
topmostSubform[0].CopyA[0].c1_3[0]_1	CheckBox	Indicate whether this checkbox is applicable for the specific condition it represents on Copy A of the form.
Local Tax Information
17 Local tax withheld	Number	Enter the amount of local tax withheld for Box 17. This is the tax withheld by local authorities.
topmostSubform[0].CopyA[0].Box17_ReadOrder[0].f1_29[0	Text	Enter additional information related to Box 17, possibly a continuation of local tax withheld details.
18 Name of locality	Text	Enter the name of the locality for Box 18. This identifies the local jurisdiction associated with the distribution.
topmostSubform[0].CopyA[0].Box18_ReadOrder[0].f1_31[0	Text	Enter additional information related to Box 18, possibly a continuation of the locality name.
topmostSubform[0].Copy1[0].Box17_ReadOrder[0].f2_28[0	Number	Enter the local tax withheld from the distribution. This is the amount of tax withheld for local tax purposes.
topmostSubform[0].Copy1[0].Box17_ReadOrder[0].f2_29[0	Text	Enter the name of the locality for which the local tax was withheld. This identifies the local tax jurisdiction.
topmostSubform[0].Copy1[0].Box18_ReadOrder[0].f2_30[0	Number	Enter the local distribution amount. This is the portion of the distribution subject to local tax.
topmostSubform[0].Copy1[0].Box18_ReadOrder[0].f2_31[0	Number	Enter the local tax withheld from the distribution. This is the amount of tax withheld for local tax purposes.
topmostSubform[0].Copy1[0].f2_32[0	Text	Enter any additional local information required for tax reporting. This may include specific local tax details.
19 Local distribution $ 1ae1	Number	Enter the local distribution amount. This is the portion of the distribution subject to local tax.
17 Local tax $53ee	Number	Enter the amount of local tax withheld from the distribution.
18 Name of locality	Text	Enter the name of the locality where the local tax was withheld.
topmostSubform[0].CopyB[0].Box18_ReadOrder[0].f2_31[0	Text	Provide additional information related to the locality, if applicable.
topmostSubform[0].Copy2[0].Box17_ReadOrder[0].f2_28[0	Number	Enter the amount for Box 17, which typically relates to local tax withheld or other local-specific information.
topmostSubform[0].Copy2[0].Box17_ReadOrder[0].f2_29[0	Text	Enter additional information for Box 17, which may include local tax details or other relevant local-specific data.
topmostSubform[0].Copy2[0].Box18_ReadOrder[0].f2_30[0	Number	Enter the amount for Box 18, which typically relates to additional local tax information or other relevant details.
topmostSubform[0].Copy2[0].Box18_ReadOrder[0].f2_31[0	Text	Enter additional information for Box 18, which may include further local tax details or other relevant data.
	Text	Provide any additional information required for local tax reporting or other relevant details.
topmostSubform[0].Copy2[0].f2_33[0	Text	Enter any additional information that may be required for local tax purposes or other relevant details.
Miscellaneous
	Text	This field is currently unnamed. Please refer to the form instructions for more details.
	Text	This field is currently unnamed. Please refer to the form instructions for more details.
	Text	This field is currently unnamed. Please refer to the form instructions for more details.
topmostSubform[0].CopyB[0].Box5_ReadOrder[0].f2_12[0	Text	This field is currently unnamed. Please refer to the form instructions for more details.
	Text	This field is currently unnamed. Please refer to the form instructions for more details.
	Text	This field is currently unnamed. Please refer to the form instructions for more details.
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 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
	Text	Enter the payer's name and address. This information is required to identify the entity making the distribution.
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
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, address, and contact information. This includes the street address, city, state, ZIP code, and phone number.
PAYER'S TIN	Text	Enter the payer's Taxpayer Identification Number (TIN). This is a unique identifier for the payer, typically an EIN. 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, address, and contact information.
PAYER'S TIN	Text	Enter the payer's Taxpayer Identification Number (TIN). Max length: 11 characters
topmostSubform[0].CopyC[0].f2_08[0	Text	Enter the payer's name. This is the entity that made the distribution to you.
	Text	Enter the payer's TIN (Taxpayer Identification Number). This is the identification number of the entity that made the distribution.
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 9-digit number. Max length: 11 characters
Payment Information
13 Date of payment	Date	Enter the date of payment. Use the format MM/DD/YYYY. Max length: 10 characters
13 Date of payment	Date	Enter the date on which the payment was made.
13 Date of payment	Date	Enter the date on which the payment was made to the recipient.
13 Date of payment	Date	Enter the date of payment for the distribution. This is the date when the payment was actually made to you.
13 Date of payment	Date	Enter the date of payment for the distribution.
Recipient Information
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.
	Text	Enter the recipient's name and address. This information is required to identify the individual receiving the distribution.
	Text	Enter the recipient's account number. This is used for the payer's records and may be helpful for identifying the account.
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.
topmostSubform[0].Copy1[0].LeftCol_ReadOrder[0].f2_06[0	Text	Enter the city or town, state or province, and ZIP or foreign postal code of the recipient.
topmostSubform[0].Copy1[0].LeftCol_ReadOrder[0].f2_07[0	Text	Enter the country of the recipient, if applicable.
RECIPIENT'S TIN	Text	Enter the recipient's Taxpayer Identification Number (TIN). This is a unique identifier for the recipient, typically a Social Security Number (SSN). Max length: 11 characters
RECIPIENT'S name	Text	Enter the full name of the recipient of the distribution.
Street address (including apt. no.)	Text	Enter the street address of the recipient, including apartment number if applicable.
topmostSubform[0].CopyB[0].f2_16[0	Text	Enter the recipient's name as it appears on their tax records.
RECIPIENT'S TIN	Text	Enter the recipient's Taxpayer Identification Number (TIN). 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.
topmostSubform[0].CopyC[0].LeftCol_ReadOrder[0].f2_06[0	Text	Provide any additional address information if required.
topmostSubform[0].CopyC[0].LeftCol_ReadOrder[0].f2_07[0	Text	Provide any additional address information if required.
topmostSubform[0].CopyC[0].f2_13[0	Text	Enter the recipient's TIN (Taxpayer Identification Number). This is your identification number for tax purposes.
	Text	Enter the recipient's name. This is your name as the recipient of the distribution.
topmostSubform[0].CopyC[0].f2_16[0	Text	Enter the recipient's address. This is your address for receiving tax documents.
RECIPIENT'S TIN	Text	Enter the Recipient's Taxpayer Identification Number (TIN). This should be a 9-digit number. Max length: 11 characters
RECIPIENT'S name	Text	Enter the full name of the recipient of the distribution.
Street address (including apt. no.)	Text	Enter the street address of the recipient, including apartment number if applicable.
topmostSubform[0].Copy2[0].LeftCol_ReadOrder[0].f2_06[0	Text	Enter additional address information for the recipient, such as city, state, and ZIP code.
Recipient's Copy Details
topmostSubform[0].CopyC[0].f2_32[0	Text	Enter the information related to the specific field on Copy C of the form. This might be a continuation or specific detail related to the recipient's copy.
	Text	Enter the information related to the specific field on Copy C of the form. This might be a continuation or specific detail related to the recipient's copy.
	Text	Enter the information related to the specific field on Copy 2 of the form. This might be a continuation or specific detail related to the recipient's copy.
	Text	Enter the information related to the specific field on Copy 2 of the form. This might be a continuation or specific detail related to the recipient's copy.
Recipient's Records
topmostSubform[0].CopyC[0].c2_1[0]_2	CheckBox	Check this box if applicable to the recipient's records.
Roth Contribution Details
11 1st year of desig. Roth contrib	Text	Enter the first year in which the recipient made a designated Roth contribution.
Roth Contributions
11 1st year of desig. Roth contrib	Text	Enter the first year of designated Roth contributions. This is the year when the recipient first made Roth contributions.
topmostSubform[0].CopyA[0].Box12-13_ReadOrder[0].c1_5[0]_1	CheckBox	Check this box if the distribution is a qualified distribution from a designated Roth account.
11 1st year of desig. Roth contrib	Text	Enter the first year in which the designated Roth contribution was made, if applicable.
11 1st year of desig. Roth contrib	Text	Enter the first year you made a designated Roth contribution. This is important for tracking the timeline of your Roth contributions.
11 1st year of desig. Roth contrib	Text	Enter the first year of designated Roth contributions.
topmostSubform[0].Copy2[0].Box12-13_ReadOrder[0].c2_5[0]_1	CheckBox	Check this box if the distribution is a qualified distribution from a designated Roth account.
Special Conditions
topmostSubform[0].CopyC[0].Box12-13_ReadOrder[0].c2_5[0]_1	CheckBox	Check this box if applicable, based on the instructions for Boxes 12-13. This may relate to specific conditions or exceptions.
State Information
15 State/Payer's state no	Text	Enter the state and the payer's state identification number, if applicable.
State Tax Information
topmostSubform[0].CopyA[0].Box14_ReadOrder[0].f1_23[0	Number	Enter the amount for Box 14, which typically relates to state tax withheld or other state-specific information.
15 State/Payer's state no	Text	Enter the state or payer's state number for Box 15. This is used to identify the state associated with the distribution.
topmostSubform[0].CopyA[0].Box15_ReadOrder[0].f1_25[0	Text	Enter additional information related to Box 15, possibly a continuation of the state or payer's state number.
topmostSubform[0].Copy1[0].c2_1[0]_1	CheckBox	Check this box if applicable for Copy 1, which is used for state tax departments.
topmostSubform[0].Copy1[0].c2_1[1]_2	CheckBox	Check this box if applicable for Copy 1, which is used for state tax departments.
topmostSubform[0].Copy1[0].Box15_ReadOrder[0].f2_25[0	Number	Enter the state tax withheld from the distribution. This is the amount of tax withheld for state tax purposes.
	Text	Enter the payer's state identification number. This is the number assigned by the state for tax reporting purposes.
topmostSubform[0].Copy1[0].f2_27[0	Text	Enter the recipient's state identification number, if applicable. This is used for state tax reporting.
	Number	Enter the amount of any state tax withheld from the distribution.
topmostSubform[0].CopyB[0].Box14_ReadOrder[0].f2_22[0	Text	Enter any additional state-specific information required for the distribution.
topmostSubform[0].CopyB[0].Box14_ReadOrder[0].f2_23[0	Text	Enter any additional state-specific information required for the distribution.
15 State/Payer's state no	Text	Enter the state and the payer's state identification number for state tax purposes.
topmostSubform[0].CopyB[0].Box15_ReadOrder[0].f2_25[0	Text	Enter any additional state-specific information required for the distribution.
topmostSubform[0].CopyB[0].Box17_ReadOrder[0].f2_28[0	Text	Enter any additional state-specific information required for the distribution.
15 State/Payer's state no	Text	Enter the state or payer's state number. This is used for state tax reporting purposes.
topmostSubform[0].CopyC[0].Box15_ReadOrder[0].f2_25[0	Text	Enter additional state tax information as required for Box 15. This may include state-specific details or identifiers.
topmostSubform[0].Copy2[0].Box14_ReadOrder[0].f2_22[0	Number	Enter the amount for Box 14, which typically relates to state tax withheld or other state-specific information.
topmostSubform[0].Copy2[0].Box14_ReadOrder[0].f2_23[0	Text	Enter additional information for Box 14, which may include state tax details or other relevant state-specific data.
15 State/Payer's state no	Text	Enter the state or payer's state number, which is used for state tax reporting purposes.
topmostSubform[0].Copy2[0].Box15_ReadOrder[0].f2_25[0	Text	Enter additional state or payer's state number information, if applicable.
	Text	Provide any additional information required for state tax reporting or other relevant details.
topmostSubform[0].Copy2[0].f2_27[0	Text	Enter any additional information that may be required for state tax purposes or other relevant details.
Tax Information
topmostSubform[0].CopyA[0].f1_18[0	Number	Enter the federal income tax withheld from the distribution. This is the amount withheld for federal taxes.
	Number	Enter the state tax withheld from the distribution. This is the amount withheld for state taxes.
tax	Number	Enter the federal income tax withheld from the distribution.
	Number	Enter the amount of the distribution that is not subject to federal income tax, if applicable.
tax	Number	Enter the tax amount related to the distribution.
tax	Number	Enter the taxable amount of the distribution. This is the portion of the distribution that is subject to federal income tax.
topmostSubform[0].CopyC[0].Box5_ReadOrder[0].f2_12[0	Number	Enter the amount of federal income tax withheld from the distribution.
tax	Number	Enter the federal income tax withheld from the distribution.

Form 1099-R, Distributions From Pensions etc. Instructions