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 Form Fields:

Field NameSizeType DescriptionNotes
See Form Filer Common FieldsFiler fields common to all form types. 
See Recipient Common FieldsRecipient fields common to all form types. 

Box 1 Amount

12Amount

Box 1: Unemployment compensation

 

Box 2 Amount

12AmountBox 2: State or local income tax refunds, credits, or offsets 

Box 3 Year

4Date

Box 3: Box 2 amount is for tax year

MM/DD/YYYY or M/D/YYYY
Box 4 Amount12AmountBox 4: Federal income tax withheld 
Box 5 Amount12AmountBox 5: RTAA payments 
Box 6 Amount12AmountBox 6: Taxable grants 
Box 7 Amount12CheckboxBox 7: Agricultural paymentsX / Y / T / 1 = Checked
Box 8 Checkbox1TextBox 8: Check if box 2 is trade or business income 
Box 9 Amount12AmountBox 9: Market gain 
Box 10a State2TextBox 10a: StateUse state abbreviation
Box 10b ID Number20TextBox 10b: State identification no.Given by State Department of Revenue
Box 11 Amount12AmountBox 11 State income tax withheld 
See Form Common FieldsForm fields common to all form types. 

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