| Field Name | Size | Type | Description | Notes |
| See Form Filer Common Fields | | | Filer fields common to all form types. | |
| See Recipient Common Fields | | | Recipient fields common to all form types. | |
| 2nd TIN Notice | 1 | Checkbox | Second TIN Notice (Optional) | X / Y / T / 1 = Checked |
| FATCA Checkbox | 1 | Checkbox | FATCA Filing Requirement Indicator | X / Y / T / 1 = Checked |
| Box 1 Amount | 12 | Amount | Box 1: Interest income | |
| Box 2 Amount | 12 | Amount | Box 2: Early withdrawal penalty | |
| Box 3 Amount | 12 | Amount | Box 3: Interest on U.S. Savings Bonds and Treas. obligations | |
| Box 4 Amount | 12 | Amount | Box 4: Federal income tax withheld | |
| Box 5 Amount | 12 | Amount | Box 5: Investment expenses | |
| Box 6 Amount | 12 | Amount | Box 6: Foreign tax paid | |
| Box 7 Foreign | 16 | Text | Box 7: Foreign Country or U.S. Possession | |
| Box 8 Amount | 12 | Amount | Box 8: Tax-exempt interest | |
| Box 9 Amount | 12 | Amount | Box 9: Specified private activity bond interest | |
| Box 10 Amount | 12 | Amount | Box 10: Market discount | |
| Box 11 Amount | 12 | Amount | Box 11: Bond premium | |
| Box 12 Amount | 12 | Amount | Box 12: Bond premium on Treasury obligations | |
| Box 13 Amount | 12 | Amount | Box 13: Bond premium on tax-exempt bond | |
| Box 14 CUSIP No | 13 | Number | Box 14: Tax-exempt bond CUSIP | |
| Box 15 State | 2 | Text | Box 15: State | Use state abbreviation |
| Box 16 ID Number | 20 | Text | Box 16: State identification no. | Given by State Department of Revenue |
| Box 17 Amount | 12 | Amount | Box 17: State tax withheld | |
