This form contains 32 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Extension (After Automatic Extension)
Additional extension requested (after automatic extension) Checkbox
Check this box only if you already requested the automatic extension and you now need an additional extension.
Extension Reason Criteria (Line 7)
Catastrophic event in a federally declared disaster area Checkbox
Check this box if the filer suffered a catastrophic event in a federally declared disaster area that made the filer unable to resume operations or made necessary records unavailable. Fill only if 'Additional extension requested (after automatic extension)', 'First Row - W-2', 'Third Row - 1099-NEC' is 'Yes' (any).
Depends on: First Row - W-2, Third Row - 1099-NEC, Additional extension requested (after automatic extension)
Death, serious illness, or unavoidable absence of responsible individual Checkbox
Check this box if the death, serious illness, or unavoidable absence of the individual responsible for filing the information returns affected the filer’s ability to file. Fill only if 'Additional extension requested (after automatic extension)', 'First Row - W-2', 'Third Row - 1099-NEC' is 'Yes' (any).
Depends on: First Row - W-2, Third Row - 1099-NEC, Additional extension requested (after automatic extension)
Fire, casualty, or natural disaster affected operations Checkbox
Check this box if a fire, casualty, or other natural disaster affected the filer’s operations and prevented timely filing. Fill only if 'Additional extension requested (after automatic extension)', 'First Row - W-2', 'Third Row - 1099-NEC' is 'Yes' (any).
Depends on: First Row - W-2, Third Row - 1099-NEC, Additional extension requested (after automatic extension)
Filer in first year of establishment Checkbox
Check this box if the filer was in its first year of establishment and needs an extension for that reason. Fill only if 'Additional extension requested (after automatic extension)', 'First Row - W-2', 'Third Row - 1099-NEC' is 'Yes' (any).
Depends on: First Row - W-2, Third Row - 1099-NEC, Additional extension requested (after automatic extension)
Did not receive required payee statement data in time Checkbox
Check this box if the filer did not receive required payee statement data (for example, Schedule K-1, Form 1042-S, or certain sick pay statements) in time to prepare an accurate information return. Fill only if 'Additional extension requested (after automatic extension)', 'First Row - W-2', 'Third Row - 1099-NEC' is 'Yes' (any).
Depends on: First Row - W-2, Third Row - 1099-NEC, Additional extension requested (after automatic extension)
Filing Method
Electronic Checkbox
Check this box if you will file the information returns electronically (e-file) — choose this option when you are submitting the returns via an electronic filing method.
Paper Checkbox
Check this box if you will file the information returns on paper — choose this option when you will mail physical paper returns instead of e-filing.
Forms Requested - First Row
First Row - W-2 Checkbox
Check this box if you are requesting an extension of time to file Form W-2 for the payer(s)/filers listed on the first row.
First Row - 5498 Checkbox
Check this box if you are requesting an extension of time to file Form 5498 for the payer(s)/filers listed on the first row.
First Row - 8027 Checkbox
Check this box if you are requesting an extension of time to file Form 8027 for the payer(s)/filers listed on the first row.
Forms Requested - Fourth Row
Form 1042-S Checkbox
Check this box if you are requesting an extension of time to file Form 1042-S.
Form 5498-SA Checkbox
Check this box if you are requesting an extension of time to file Form 5498‑SA.
Form 1099‑QA Checkbox
Check this box if you are requesting an extension of time to file Form 1099‑QA.
Forms Requested - Second Row
Second Row - 1097, 1098, 1099, 3921, 3922, W-2G Checkbox
Check this box if you are requesting an extension of time to file any of the information returns listed (1097, 1098, 1099, 3921, 3922, or W-2G).
Second Row - 5498‑ESA Checkbox
Check this box if you are requesting an extension of time to file the 5498‑ESA information return.
Second Row - 1094‑C, 1095‑C Checkbox
Check this box if you are requesting an extension of time to file either the 1094‑C or 1095‑C information return.
Forms Requested - Third Row
Third Row - 1099-NEC Checkbox
Check this box if you are requesting an extension to file Form 1099-NEC.
Third Row - 5498-QA Checkbox
Check this box if you are requesting an extension to file Form 5498-QA.
Third Row - 1095-B Checkbox
Check this box if you are requesting an extension to file Form 1095-B.
Payer/Filer Information
Payer/Filer's name Text
Enter the payer's or filer's full legal name (business or individual) as shown on tax records.
Address Text
Enter the street mailing address, including suite or apartment number if applicable.
City Text
Enter the city or town for the payer's mailing address.
State Text
Enter the U.S. state for the mailing address (preferably the two-letter state abbreviation).
Max length: 2 characters
ZIP code Text
Enter the ZIP code for the mailing address (5-digit ZIP or ZIP+4 if available).
Max length: 10 characters
Contact name Text
Enter the name of the person the IRS can contact regarding this extension request.
Telephone number Text
Enter a daytime telephone number, including area code, where the contact can be reached.
Email address Text
Enter the contact's email address for correspondence about this filing extension.
Taxpayer identification number (TIN) Text
Enter the payer's nine-digit Taxpayer Identification Number (EIN or SSN) without hyphens.
Max length: 9 characters
Signer Title and Date
Signer Title Text
Enter the signer’s official role or job title (for example, Owner, President, Treasurer, or Authorized Agent).
Signature Date Date
Enter the date on which the signer signed the form.
Total Number of Payers/Filers (Multiple Requests)
Total number of payers/filers Number
Enter the total number of payers/filers for whom you are requesting an extension (attach a typed list of names and TINs); if you are filing a separate Form 8809 for each payer/filer, leave this blank.