This form contains 31 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].f1_10[0 Text
Enter any additional information or comments related to the extension request.
Contact Information
Contact name Text
Enter the name of the contact person for the payer or filer.
Telephone number Text
Enter the telephone number of the contact person.
Email address Text
Enter the email address of the contact person.
Extension Request
topmostSubform[0].Page1[0].Line3[0].c1_1[0]_1 CheckBox
Check this box if you are requesting an extension for Form W-2.
topmostSubform[0].Page1[0].Line3[0].c1_1[1]_2 CheckBox
Check this box if you are requesting an extension for Form 1099.
topmostSubform[0].Page1[0].c1_3[0]_1 CheckBox
Check this box if you are requesting an additional extension beyond the initial request.
topmostSubform[0].Page1[0].Table_Line6[0].Row1[0].c1_4[0]_1 CheckBox
Check this box if you are requesting an extension for Form W-2.
topmostSubform[0].Page1[0].Table_Line6[0].Row1[0].c1_5[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1099.
topmostSubform[0].Page1[0].Table_Line6[0].Row1[0].c1_6[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1098.
topmostSubform[0].Page1[0].Table_Line6[0].Row2[0].c1_7[0]_1 CheckBox
Check this box if you are requesting an extension for Form 5498.
topmostSubform[0].Page1[0].Table_Line6[0].Row2[0].c1_8[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1042-S.
topmostSubform[0].Page1[0].Table_Line6[0].Row2[0].c1_9[0]_1 CheckBox
Check this box if you are requesting an extension for Form 8027.
topmostSubform[0].Page1[0].Table_Line6[0].Row3[0].c1_10[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1094-C.
topmostSubform[0].Page1[0].Table_Line6[0].Row3[0].c1_11[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1095-C.
topmostSubform[0].Page1[0].Table_Line6[0].Row3[0].c1_12[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1097.
topmostSubform[0].Page1[0].Table_Line6[0].Row4[0].c1_13[0]_1 CheckBox
Check this box if you are requesting an extension for Form W-2.
topmostSubform[0].Page1[0].Table_Line6[0].Row4[0].c1_14[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1099.
topmostSubform[0].Page1[0].Table_Line6[0].Row4[0].c1_15[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1098.
topmostSubform[0].Page1[0].c1_16[0]_1 CheckBox
Check this box if you are requesting an extension for Form 5498.
topmostSubform[0].Page1[0].c1_17[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1042-S.
topmostSubform[0].Page1[0].c1_18[0]_1 CheckBox
Check this box if you are requesting an extension for Form 8027.
topmostSubform[0].Page1[0].c1_19[0]_4 CheckBox
Check this box if you are requesting an extension for Form 1094-C.
topmostSubform[0].Page1[0].c1_20[0]_1 CheckBox
Check this box if you are requesting an extension for Form 1095-C.
Payer Information
Payer's/filer's name Text
Enter the name of the payer or filer requesting the extension.
Address Text
Enter the address of the payer or filer.
City Text
Enter the city of the payer or filer's address.
State Text
Enter the state abbreviation (2 characters) of the payer or filer's address.
Max length: 2 characters
ZIP code Text
Enter the ZIP code of the payer or filer's address (up to 10 characters).
Max length: 10 characters
topmostSubform[0].Page1[0].Line2CombField[0].f1_9[0 Text
Enter the taxpayer identification number (TIN) of the payer or filer (up to 9 characters).
Max length: 9 characters
Title Text
Enter the title of the person requesting the extension.