IRS Release Status:FINAL

Import 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.

Form Lump Sum Checkbox

1Checkbox

Form of distribution is lump sum

X / Y / T / 1 = Checked

Form Partial Checkbox

1CheckboxForm of distribution is partialX / Y / T / 1 = Checked

Form Annuity Checkbox

1Checkbox

Form of distribution is annuity

X / Y / T / 1 = Checked
Plan Governmental Checkbox1CheckboxPlan or annuity type is governmentalX / Y / T / 1 = Checked
Plan Qual Private Checkbox1CheckboxPlan or annuity type is qualified privateX / Y / T / 1 = Checked
Plan Non Qualitified Checkbox1CheckboxPlan or annuity type is non qualifiedX / Y / T / 1 = Checked
Pension Start Date8DateDate you started receiving the pensionMM/DD/YYYY or M/D/YYYY
Box 1 Amount12AmountRollover contribution
Box 2 Amount12AmountRollover distribution
Box 3 Amount12AmountAnnuity cost
Box 4 Amount12AmountGovernmental retirement fund
Box 5 Amount12AmountTax w/h from annuity or periodic payment
Box 6 Amount12AmountTax w/h from lump sum distrib (20%)
Box 7 Amount12AmountTax w/h from lump sum distrib (10%)
Box 8 Amount12AmountTax w/h from lump sum distrib (8%)
Box 9 Amount12AmountTax w/h other distrib qual plans (10%)
Box 10 Amount12AmountTax w/h from dist of non-qual plans
Box 11 Amount12AmountTax w/h rollover to non deduct IRA
Box 12 Amount12AmountTax w/h retire savings acct dist (10%)
Box 13 Amount12AmountTax w/h roll rsa to non ded ira (10%)
Box 14 Amount12AmountTax w/h nonresident distribution
Box 15 Amount12AmountTax w/h other distribution
Box 16 Amount12AmountAmount distributed
Box 17 Amount12AmountTaxable amount
Box 18 Amount12AmountAmt over which prepayment made
Box 19a Amount12AmountDistribution deferred contributions
Box 19b Amount12AmountDistribution after-tax contributions
Box 19c Amount12AmountDistribution income accretion
Box 19d Amount12AmountDistribution others
Box 19e Amount12AmountDist total (lines 19a through 19d)
Box 20 Code1TextDistribution code
See Form Common FieldsForm fields common to all form types.
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