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1099-R

Step 1 of 2

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- Email Information
  Insert the e-mail address to which you want to receive your 1099-R form
- Email*
- General Information
- Tax Year
- Payer's Information
- PAYER'S name, street address, city or town, state or province, country, ZIP
- Payer's TIN
- Recipient’s Information
- Recipient’s Name
- Recipient’s TIN
- Recipient’s Address
- Street Address(including apt. no.)
- City or town, state or province, country, and ZIP or foreign postal code
- Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
- Account Number
- FATCA Filing Requirement
  - FATCA Filing Requirement
- 1. Gross Distribution
- 2a. Taxable Amount
- untitled
  - 2b. Taxable amount not determined
- untited
  - 2b. Total distribution
- 3. Capital Gain
- 4. Federal income tax withheld
- 5. Employee contributions / Designated Roth contributions or insurance premiums $
- 6. Net unrealized appreciation in employer’s securities
- 7. Distribution Code(s)
  - 1—Early distribution, no known exception
  - 2—Early distribution, exception applies.
  - 3—Disability.
  - 4—Death.
  - 5—Prohibited transaction.
  - 6—Section 1035 exchange.
  - 7—Normal distribution
  - 8—Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2023
  - 9—Cost of current life insurance protection.
  - A—May be eligible for 10-year tax option.
  - B—Designated Roth account distribution.
  - C—Reportable death benefits under section 6050Y.
  - D—Annuity payments from nonqualified annuities and distributions from life insurance contracts that may be subject to tax under section 1411
  - E—Distributions under Employee Plans Compliance Resolution System (EPCRS).
  - F—Charitable gift annuity.
  - G—Direct rollover and direct payment.
  - H—Direct rollover of a designated Roth account distribution to a Roth IRA.
  - J—Early distribution from a Roth IRA.
  - K—Distribution of traditional IRA assets not having a readily available FMV.
  - L—Loans treated as deemed distributions under section 72(p).
  - M—Qualified plan loan offset.
  - N—Recharacterized IRA contribution made for 2022.
  - P—Excess contributions plus earnings/excess deferrals taxable in 2021.
  - Q—Qualified distribution from a Roth IRA.
  - R—Recharacterized IRA contribution made for 2021.
  - S—Early distribution from a SIMPLE IRA in the first 2 years, no known exception.
  - T—Roth IRA distribution, exception applies
  - U—Dividends distributed from an ESOP under section 404(k).
  - W—Charges or payments for purchasing qualified long-term care insurance contracts under combined arrangements.
- Untitled
  - Check this box in the IRA/SEP/SIMPLE checkbox if the distribution is from a traditional IRA, SEP IRA, or SIMPLE IRA. Do not check the box for a distribution from a Roth IRA or for an IRA recharacterization
- 8. Enter the current actuarial value of an annuity contract that is part of a lump-sum distribution.
- 8. Enter the percentage (%) of the total annuity contract
- 9a. Your Percentage of Total Distribution
- 9b. Total Employee Contributions
- 10. Amount Allocable to IRR Within 5 Years
- 11. 1st Year of Designated Roth Contribution
- 13. Date of Payment
  MM slash DD slash YYYY
- 14. State income tax withheld (Line 1)
- 15. State/Payer’s state no. (Line 1)
- 16. State distribution (Line 1)
- Do you wish to enter another state income tax withheld?
  - YES
  - NO
- 14. State income tax withheld (Line 2)
- 15. State/Payer’s state no. (Line 2)
- 16. State distribution (Line 2)
- 17. Local tax withheld (Line 1)
- 18. Name of locality (Line 1)
- 19. Local distribution (Line 1)
- Do you wish to enter another local tax withheld for your locality?
  - YES
  - NO
- 17. Local tax withheld (Line 2)
- 18. Name of locality (Line 2)
- 19. Local distribution (Line 1)
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