| # | Id | Type | Description |
| 1 | foreignAccountTaxCompliance | boolean | FATCA filing requirement |
| 2 | accountNumber | string | Account number |
| 3 | originalIssueDiscount | number | Box 1, Original issue discount |
| 4 | otherPeriodicInterest | number | Box 2, Other periodic interest |
| 5 | earlyWithdrawalPenalty | number | Box 3, Early withdrawal penalty |
| 6 | federalTaxWithheld | number | Box 4, Federal income tax withheld |
| 7 | marketDiscount | number | Box 5, Market discount |
| 8 | acquisitionPremium | number | Box 6, Acquisition premium |
| 9 | oidDescription | string | Box 7, Description |
| 10 | discountOnTreasuryObligations | number | Box 8, Original issue discount on U.S. Treasury obligations |
| 11 | investmentExpenses | number | Box 9, Investment expenses |
| 12 | bondPremium | number | Box 10, Bond premium |
| 13 | taxExemptOid | number | Box 11, Tax-exempt OID |
| 14 | stateAndLocal | Array of StateAndLocalTaxWithholding | Boxes 12-14, State and Local tax withheld |
| 15 | stateExemptOid | Array of DescriptionAmount | Supplemental: State name and tax-exempt OID by state |
| 16 | secondTinNotice | boolean | Second TIN Notice |