This form contains 63 fields organized into 19 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 IRA. Refer to the form instructions for guidance.
Number
Enter the fair market value of the account as of December 31 of the previous year.
Account number (see instructions) Text
Enter the account number associated with the participant's IRA, as per the form instructions.
Additional Contributions/Distributions
Number
Enter the amount of any other contributions or distributions not covered by other fields.
Additional Information
Text
Enter any other relevant information related to the account.
Text
Enter any other information related to the IRA that is not covered by other fields.
Codes and Identifiers
13c Code Text
Enter the code that corresponds to the type of contribution or distribution.
Contribution/Distribution Details
10 Text
Enter the specific information or value required for box 10 as per the form instructions.
Text
Enter the specific information or value required for this field as per the form instructions.
Text
Enter the specific information or value required for this field as per the form instructions.
Text
Enter the specific information or value required for this field as per the form instructions.
Text
Enter the specific information or value required for this field as per the form instructions.
Text
Enter the specific information or value required for this field as per the form instructions.
Text
Enter the specific information or value required for this field as per the form instructions.
14b Code Text
Enter the appropriate code for Box 14b, which indicates the type of IRA contribution or distribution.
Text
Provide the information required for Box 15a, as per the form instructions.
specified Text
Specify the details as required in the form instructions for this field.
Text
Provide the information required for this field as per the form instructions.
Text
Provide the information required for this field as per the form instructions.
4 Number
Enter the amount or information required for Box 4, as per the form instructions.
Text
Provide the information required for this field as per the form instructions.
Distributions
12a RMD date Date
Enter the required minimum distribution (RMD) date for the account holder.
Form Information
13b Year Text
Enter the tax year for which the form is being completed. This should be a four-digit year.
Max length: 4 characters
General Information
topmostSubform[0].CopyA[0].c1_1[0]_1 CheckBox
Check this box if the information pertains to a specific condition or requirement as indicated in the form instructions.
topmostSubform[0].CopyA[0].c1_1[1]_2 CheckBox
Check this box if the information pertains to a specific condition or requirement as indicated in the form instructions.
13b Year Text
Enter the year for which the information is being reported. This should be a 4-digit year.
Max length: 4 characters
IRA Contributions
topmostSubform[0].CopyA[0].RightCol[0].c1_3[1]_2 CheckBox
Check this box if the account holder has made contributions to a traditional IRA.
topmostSubform[0].CopyA[0].RightCol[0].c1_3[2]_3 CheckBox
Check this box if the account holder has made contributions to a Roth IRA.
topmostSubform[0].CopyA[0].RightCol[0].c1_3[3]_4 CheckBox
Check this box if the account holder has made contributions to a SEP IRA.
Number
Enter the total amount of contributions made to the account during the year.
topmostSubform[0].CopyA[0].RightCol[0].c1_4[0]_1 CheckBox
Check this box if the account holder has made contributions to a SIMPLE IRA.
Number
Enter the total contributions made to the IRA for the tax year.
IRA Contributions and Distributions
13c Code Text
Enter the code for Box 13c, which indicates the type of contribution or distribution related to the IRA account.
Number
Enter the amount or information related to Box 14a, which may pertain to specific IRA transactions or values.
14b Code Text
Enter the code for Box 14b, which specifies the type of transaction or condition related to the IRA account.
Number
Enter the amount or information related to Box 15a, which may involve specific IRA transactions or values.
15b Code(s) Text
Enter the code(s) for Box 15b, which indicate the type of transaction or condition related to the IRA account.
IRA Conversions
Number
Enter the amount of any Roth IRA conversions.
IRA Information
Number
Enter the fair market value of the IRA as of December 31 of the previous year.
IRA Recharacterizations
Number
Enter the amount of any recharacterizations made during the year.
Number
Enter the amount of any recharacterized contributions made to the IRA.
IRA Rollovers
Number
Enter the amount of any rollover contributions made to the IRA.
Number
Enter the amount of any late rollover contributions.
IRA Rollovers/Conversions
Number
Enter the amount of any rollovers or conversions made to the account during the year.
IRA Type
topmostSubform[0].CopyB[0].RightCol[0].c2_3[0]_1 CheckBox
Check this box if the IRA is a traditional IRA.
topmostSubform[0].CopyB[0].RightCol[0].c2_3[1]_2 CheckBox
Check this box if the IRA is a Roth IRA.
topmostSubform[0].CopyB[0].RightCol[0].c2_3[2]_3 CheckBox
Check this box if the IRA is a SEP IRA.
topmostSubform[0].CopyB[0].RightCol[0].c2_3[3]_4 CheckBox
Check this box if the IRA is a SIMPLE IRA.
topmostSubform[0].CopyB[0].RightCol[0].c2_4[0]_1 CheckBox
Check this box if the IRA is an inherited IRA.
Participant Information
PARTICIPANT'S TIN Text
Enter the Taxpayer Identification Number (TIN) of the participant. This should be a 9-digit number.
Max length: 11 characters
PARTICIPANT'S name Text
Enter the full name of the participant.
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 for the participant.
topmostSubform[0].CopyA[0].RightCol[0].c1_3[0]_1 CheckBox
Check this box if the account holder is a participant in a retirement plan.
topmostSubform[0].CopyB[0].c2_1[0]_2 CheckBox
Check this box if applicable, as per the instructions on Copy B of the form.
PARTICIPANT'S TIN Text
Enter the Taxpayer Identification Number (TIN) of the participant. This should be a 9-digit number.
Max length: 11 characters
PARTICIPANT'S name Text
Enter the full name of the participant.
Street address (including apt. no.) Text
Enter the street address of the participant, 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 participant.
RMD Information
12a RMD date Date
Enter the required minimum distribution (RMD) date for the IRA.
Trustee/Issuer Information
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Text
Enter the full name, street address, city or town, state or province, country, and ZIP or foreign postal code of the trustee or issuer.
TRUSTEE'S or ISSUER'S TIN Text
Enter the Taxpayer Identification Number (TIN) of the trustee or issuer. This should be a 9-digit number.
Max length: 11 characters
TRUSTEE’S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Text
Enter the full name, street address, city or town, state or province, country, and ZIP or foreign postal code of the trustee or issuer.
TRUSTEE'S or ISSUER'S TIN Text
Enter the Taxpayer Identification Number (TIN) of the trustee or issuer. This should be a 9-digit number.
Max length: 11 characters