This form contains 23 fields organized into 2 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Personal Information
Name(s) shown on return Text
Enter the name(s) exactly as shown on your tax return.
Your social security number Text
Enter your social security number. Ensure it is exactly 11 characters long, including dashes.
Max length: 11 characters
1 Text
Enter the taxpayer's name as it appears on their tax return.
2 Text
Enter the taxpayer's social security number.
topmostSubform[0].Page2[0].Col2[0].Pg2Worksheet[0].f2_3[0 Text
Enter the taxpayer's filing status (e.g., single, married filing jointly).
Retirement Contributions
1 Text
Enter the amount of contributions made to qualified retirement accounts for the first row.
topmostSubform[0].Page1[0].Table_Ln1-6[0].BodyRow1[0].f1_4[0 Text
Enter the amount of contributions made to qualified retirement accounts for the second row.
topmostSubform[0].Page1[0].Table_Ln1-6[0].BodyRow2[0].f1_5[0 Text
Enter the amount of contributions made to qualified retirement accounts for the third row.
topmostSubform[0].Page1[0].Table_Ln1-6[0].BodyRow2[0].f1_6[0 Text
Enter the amount of contributions made to qualified retirement accounts for the fourth row.
3 3 Text
Enter the amount of contributions made to qualified retirement accounts for the fifth row.
3 3 234c Text
Enter the amount of contributions made to qualified retirement accounts for the sixth row.
topmostSubform[0].Page1[0].Table_Ln1-6[0].BodyRow4[0].f1_9[0 Text
Enter the amount of contributions made to qualified retirement accounts for the seventh row.
topmostSubform[0].Page1[0].Table_Ln1-6[0].BodyRow4[0].f1_10[0 Text
Enter the amount of contributions made to qualified retirement accounts for the eighth row.
5 Text
Enter the amount of contributions made to qualified retirement accounts for the ninth row.
topmostSubform[0].Page1[0].Table_Ln1-6[0].BodyRow5[0].f1_12[0 Text
Enter the amount of contributions made to qualified retirement accounts for the tenth row.
6 Text
Enter the total amount of qualified retirement savings contributions made during the tax year.
topmostSubform[0].Page1[0].Table_Ln1-6[0].BodyRow6[0].f1_14[0 Text
Enter the total amount of qualified retirement savings contributions made during the tax year.
topmostSubform[0].Page1[0].f1_15[0 Text
Enter the total amount of qualified retirement savings contributions made during the tax year.
8 Text
Enter the total amount of qualified retirement savings contributions made during the tax year.
topmostSubform[0].Page1[0].f1_17[0 Text
Enter the total amount of qualified retirement savings contributions made during the tax year.
10 Text
Enter the total amount of qualified retirement savings contributions made during the tax year.
topmostSubform[0].Page1[0].f1_19[0 Text
Enter the total amount of qualified retirement savings contributions made during the tax year.
12 Text
Enter the total amount of qualified retirement savings contributions made during the tax year.