| 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. | |||
| Issuer's TIN | 1 | Amount | Issuer's TIN | |
Participant's TIN | 1 | Amount | Participant's TIN | |
Box 1a | 12 | Amount | Box 1a: Annuity amount on start date | |
| Box 1b | 12 | Amount | Box 4: Adjustments made for a prior year | |
| Box 2 | 12 | Amount | Box 5: Scholarships or grants | |
| Box 3 | 12 | Amount | Box 6: Adjustments to scholarships or grants for a prior year | |
| Box 4 | 1 | Checkbox | Box 7: Check this box if the amount in box 1 or 2 includes amounts... | X / Y / T / 1 = Checked |
| Box 5 | 1 | Checkbox | Box 8: Check if at least half-time student | X / Y / T / 1 = Checked |
| Box 5a | 1 | Checkbox | Box 9: Check if a graduate student | X / Y / T / 1 = Checked |
| Box 5b | 12 | Amount | Box 10: Ins. contract reimb./refund | |