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Field NameSizeType DescriptionNotes
See Form Filer Common Fields Filer fields common to all form types. 
See Recipient Common Fields Recipient fields common to all form types. 
FATCA Checkbox1CheckboxFATCA filing requirementX / Y / T / 1 = Checked

Box 1 Amount

12AmountGross distribution 

Box 2a Amount

12AmountTaxable amount 
Box 2b Checkbox 11CheckboxTaxable amount not determinedX / Y / T / 1 = Checked
Box 2b Checkbox 21CheckboxTotal distributionX / Y / T / 1 = Checked
Box 3 Amount12AmountCapital gain (included in box 2a) 
Box 4 Amount12AmountFederal income tax withheld 
Box 5 Amount12AmountEmployee contributions/Designated Roth contribution or insurance premiums 
Box 6 Amount12AmountNet unrealized appreciation in employer's securities 
Box 7 Code(s)2TextDistribution CodeSee IRS instructions
Box 8 Amount12AmountOther 
Box 8 Number2NumericOther percentage0 - 99

Box 9a Number

2NumericYour percentage of total distribution0 - 99
Box 9b Amount12AmountTotal employee contributions 
Box 10 Amount12AmountAmount allocable to IRR within 5yrs 
Box 11 Roth Year4Numeric1st year of Roth contributionYYYY
Box 12 Amount12AmountState tax withheld 
Box 13 ID Number20TextState/Payer's state no.Given by State Department of Revenue
Box 13 State2TextState abbreviation codeUse state abbreviation
Box 14 Amount12AmountState distribution 
Box 15 Amount12AmountLocal tax withheld 
Box 16 Name15TextName of locality 
Box 17 Amount12AmountLocal distribution 
See Form Common FieldsForm fields common to all form types. 

1099-R Form:

Image Added


IRS 1099-R Form: 
Download Attachment Link
link1099-R Form

IRS 1099-R Instructions: 
Download Attachment Link
link1099-R Instructions