This form contains 23 fields organized into 4 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Information
topmostSubform[0].Page1[0].c1_1[0]_1 CheckBox
Check this box if applicable.
topmostSubform[0].Page1[0].f1_10[0 Text
Provide additional information as required.
topmostSubform[0].Page1[0].c1_1[1]_2 CheckBox
Check this box if applicable.
topmostSubform[0].Page1[0].f1_11[0 Text
Provide additional information as required.
Personal Information
Name(s) shown on return Text
Enter the name(s) as shown on your tax return.
Identifying number Text
Enter your identifying number, such as your Social Security Number (SSN) or Employer Identification Number (EIN).
Max length: 11 characters
Text
Provide additional personal information as required.
City, town, or post office, state, and ZIP code. If you have address, see instructions Text
Enter your city, town, or post office, state, and ZIP code. Refer to the instructions if you have a different address.
topmostSubform[0].Page1[0].f1_15[0 Text
Provide your full name as it appears on your tax return.
topmostSubform[0].Page1[0].f1_16[0 Text
Enter your Social Security Number (SSN) or Taxpayer Identification Number (TIN).
topmostSubform[0].Page1[0].f1_17[0 Text
Enter your current address, including street, city, state, and ZIP code.
Reason for Extension
topmostSubform[0].Page1[0].f1_19[0 Text
Provide a detailed explanation of the undue hardship that prevents you from paying your tax on time. Include any supporting documentation.
Tax Information
20 bc to 0050 20 5e Text
Provide the specific tax year or period for which you are requesting an extension.
20 Text
Enter the last two digits of the tax year for which you are requesting an extension.
Max length: 2 characters
20 bc to Text
Provide the specific tax year or period for which you are requesting an extension.
20 bc to 0050 20 Text
Enter the last two digits of the tax year for which you are requesting an extension.
Max length: 2 characters
to pay tax of Text
Specify the amount of tax you are unable to pay on time.
This request is for calendar year 20 Text
Enter the calendar year for which this extension request is being made.
Max length: 2 characters
or fiscal year ending Text
Enter the ending date of the fiscal year for which this extension request is being made.
topmostSubform[0].Page1[0].f1_14[0 Text
Enter the tax year for which you are requesting an extension. Use a two-digit format (e.g., '21' for 2021).
Max length: 2 characters
topmostSubform[0].Page1[0].f1_18[0 Text
Specify the amount of tax you owe for the tax year in question.
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
Check this box if you are requesting an extension for an individual tax return.
topmostSubform[0].Page1[0].c1_3[0]_1 CheckBox
Check this box if you are requesting an extension for a business tax return.