This form contains 38 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Deductions
b State, local, and foreign income tax (see instructions) 9b Text
Enter the amount of state, local, and foreign income tax paid. Refer to the instructions for more details.
Miscellaneous investment expenses (see instructions) 9c C Text
Enter any miscellaneous investment expenses. Refer to the instructions for more details.
9d Text
Enter any other deductions related to your investment income.
b Deductions for distributions of net investment income and charitable deductions (see instructions) 18b Text
Enter the deductions for distributions of net investment income and charitable deductions as per the instructions.
Income Adjustments
b Adjustment for net income or loss derived in the ordinary course of a non--section 1411 trade or business (see instructions) 4b Text
Enter the adjustment for net income or loss derived in the ordinary course of a non-section 1411 trade or business. Refer to the form instructions for details.
6 6 Adjustments to investment income for certain CFCs and PFICS (see instructions) Text
Enter adjustments to investment income for certain Controlled Foreign Corporations (CFCs) and Passive Foreign Investment Companies (PFICs). Refer to the instructions for more details.
7 7 Other modifications to investment income (see instructions) Text
Enter any other modifications to your investment income. Refer to the instructions for more details.
10 Additional modifications (see instructions) 10 Text
Enter any additional modifications to your investment income. Refer to the instructions for more details.
Income Information
19a Adjusted gross income (see instructions) Text
Enter the adjusted gross income as per the instructions.
Income Reporting
4a Rental real estate, royalties, partnerships, S corporations, trusts, trades or businesses, etc. (see instructions) . 4a Text
Enter the amount of rental real estate, royalties, partnerships, S corporations, trusts, trades or businesses income. Refer to the form instructions for details.
4c Text
Enter the relevant information as required by the form instructions.
topmostSubform[0].Page1[0].f1_9[0 Text
Enter the relevant information as required by the form instructions.
topmostSubform[0].Page1[0].f1_10[0 Text
Enter the relevant information as required by the form instructions.
topmostSubform[0].Page1[0].f1_11[0 Text
Enter the taxable interest income you received.
topmostSubform[0].Page1[0].f1_12[0 Text
Enter the total amount of dividends you received.
8 Text
Enter the total amount of annuities you received.
topmostSubform[0].Page1[0].f1_16[0 Text
Enter the total amount of rental income you received.
11 Text
Enter the total amount of other investment-related income you received.
topmostSubform[0].Page1[0].f1_23[0 Text
Enter the total amount of other investment-related income you received.
Part I - Checkboxes
topmostSubform[0].Page1[0].PartI[0].c1_1[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
topmostSubform[0].Page1[0].PartI[0].c1_2[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
topmostSubform[0].Page1[0].PartI[0].c1_3[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
Part I - Text Fields
topmostSubform[0].Page1[0].f1_3[0 Text
Enter the relevant information as required by the form instructions.
topmostSubform[0].Page1[0].f1_4[0 Text
Enter the relevant information as required by the form instructions.
topmostSubform[0].Page1[0].f1_5[0 Text
Enter the relevant information as required by the form instructions.
Personal Information
Name(s) shown on your tax return Text
Enter the name(s) exactly as shown on your tax return.
Your social security number or EIN Text
Enter your social security number (SSN) or employer identification number (EIN). This should be a 9-digit number.
Max length: 11 characters
Tax Computation
12 Net investment income. Subtract Part II, line 11, from Part I, line 8. Individuals, complete lines 13-17. Individuals Text
Calculate your net investment income by subtracting the total deductions (Part II, line 11) from the total investment income (Part I, line 8).
14 Threshold based on filing status (see instructions) 14 Text
Enter the threshold amount based on your filing status. Refer to the instructions for more details.
15 Text
Enter any other relevant information required for the computation of your net investment income tax.
16 16 Text
Enter any other relevant information required for the computation of your net investment income tax.
Tax Computations
17 Net investment income tax for individuals. Multiply line 16 by 3.8% (0.038). Enter here and include on your tax return (see instructions). 17 Text
Enter the net investment income tax for individuals by multiplying the amount on line 16 by 3.8% (0.038). This value should be included on your tax return as per the instructions.
b Highest tax bracket for estates and trusts for the year (see instructions) 19b Text
Enter the highest tax bracket for estates and trusts for the year as per the instructions.
Subtract line 19b from line 19a. If zero or less, enter -0--C 19c Text
Subtract the amount on line 19b from the amount on line 19a. If the result is zero or less, enter -0-.
21 Net investment income tax for estates and trusts. Multiply line 20 by 3.8% (0.038). Enter here and include on your tax return (see instructions) 21 Text
Enter the net investment income tax for estates and trusts by multiplying the amount on line 20 by 3.8% (0.038). This value should be included on your tax return as per the instructions.
Uncategorized
topmostSubform[0].Page1[0].f1_28[0 Text
This field appears to be missing a description. Please refer to the form instructions for more details.
18c Text
This field appears to be missing a description. Please refer to the form instructions for more details.
20 Text
This field appears to be missing a description. Please refer to the form instructions for more details.