Guidelines for Providers

Mississippi Guidelines for Providers of Substitute Tax Forms
Prior to 2013

Update

The Mississippi Department of Revenue (DOR) is in the process of changing the current forms approval process along with the guidelines for providers of substitute tax forms. Look for these changes to be posted in the very near future.

Background

DOR implemented a new tax processing system in 1996 that incorporates scanning/imaging technology for capturing data from paper tax forms. This system currently processes only 1D barcodes but the possibility of 2D barcodes is being looked at for future use. DOR will only accept two types of forms:

1. "Official" forms printed and distributed by the DOR

2. "Approved Substitute" forms produced by external computerized tax processing software vendors

"Official" forms are printed in two colors - black ink and "drop-out" color ink. The "drop-out" ink color is invisible to the scanner. Because of this color printing, photocopies, which create black ink only forms, are not acceptable.

"Approved Substitute" forms must be completed on a computer and it is highly recommended that the returns be printed on a high quality laser printer. In all probability, returns printed on a high quality ink jet printer will also be acceptable. If the use of a dot matrix printer is anticipated, it is strongly suggested that the software vendor performs additional testing to ensure that we can accurately process such returns. All substitute forms must be submitted to DOR for approval prior to distribution and use by the general public. The approval of these forms is for use in a software package sold by the provider. Under no condition are these forms to be placed on a provider internet site, without the approval of the DOR. Any deviation from the approved substitute version of the form may lead to the imposition of a penalty of $25.00 for each unapproved form submitted with a return. The penalty may be assessed to providers who distribute unapproved forms, the tax practitioner who prepares the form or the taxpayer who submits the unapproved forms to the DOR.

On smaller coupon size forms, such as estimate payment vouchers, scanbands will not be used. For those forms that contain a scanband, the critical areas are the barcode, the registration marks and the scanband area. These areas must strictly conform to the samples and key provided. Exact positioning of these items is required. The remaining body of the form may vary a small amount as long as the form remains clear and understandable to a user. For forms that are coupon size, the data will be picked up directly from the body of the form so there must be strict compliance with exact positioning of all elements and areas on these smaller forms.

Because of legislative requirements, equipment innovations and procedural improvements, these guidelines may be subject to change at any time.

What's in the Provider Forms Packet

DOR provides a template substitute form for providers to use to create their versions of the from. These templates are found on our web-page. This "Provider Packet" includes the following:

Key to the Form

Forms - Form with data fields shown in dotted line boxes with labels that indicate where the data comes from in the body of the form, form with grid positions of each data field in the scanband, and form with data entered as a sample, formatted as DOR expects.

Additional instructions for the form (if any).

Key to the Form

All forms include a key to the data fields for the form. The key specifies the position of the barcode, registration marks, and data capture areas. The key also contains the proper data format for all data fields. A sample for the Key to the Individual Income Tax Form 80-105-99-5-1-000 is included in Appendix A. Provider forms must match the key to be approved.

Forms

Three versions of a form are included for each page of the form. The first page is the form with data fields outlined in dashed line boxes and labels to indicate where the data comes from in the body of the form. These boxes indicate the areas within which the data must hit in order to be captured by our imaging equipment. The second version of the form shows the beginning and ending grid space that the data is to cover on a 10/6 grid. The third version of the form shows the form with sample data entered. The formatting of the data on your provider form must match the layout of the sample data. In the scanband there is to be no punctuation or formatting information except the use of a negative sign (-) to indicate a negative amount when the amount field can be either positive or negative. The body of the form should mimic the sample form. Each preparer must submit five (5) original forms with this sample data properly laid out and formatted with the submission for approval. For individual income tax, five (5) samples of each filing status should be included. For individual income tax the five samples should be one (1) of each of the five filing statues.

Other Instructions About Substitute Forms

A software provider must furnish information about the requirements for DOR forms to the purchasers of its software including the following:

  • Instructions on completing the form
  • Preparation requirements for filing
  • Penalty provisions for noncompliance with preparation and filing requirements.

Instructions

If a form has separate instructions from those printed on the form, these instructions will also be included in the Provider Packet. These instructions should be given to the taxpayer. The instructions do not need to be submitted to DOR for approval.

Preparation Requirements

Substitute forms must be completed by computer and it is highly recommended that the returns be printed on a high quality laser printer. In all probability, returns printed on a high quality ink jet printer will also be acceptable. If the use of a dot matrix printer is anticipated, it is strongly suggested that the software vendor perform additional testing to ensure that we can accurately process such returns. Hand printing (other than the Signatures) on a substitute form is not acceptable.

The font for data must be Courier 12 point font.

All returns submitted must be originals. Photocopies are not acceptable.

Penalty Provisions

Substitute forms that do not comply with the Provider Packet (including the Key, Forms and Instructions) are subject to penalties. A penalty of $25.00 per form in a return may be assessed to tax software providers who distribute unapproved forms, tax practitioners who improperly use substitute forms to prepare returns, or the taxpayer who submits the non-compliant return.

The DOR strongly encourages providers and to read and understand the guidelines detailed in this document prior to submitting any forms to the DOR for approval.

All providers of substitute forms must update their software package with any revised form yearly. The substitute forms will be updated on a yearly basis. Substitute forms must be approved annually, even if no change has been made to the forms from the previous year.

What Must Be Submitted for Approval

The form that must be submitted is the final version of the form that will be printed and filed with the DOR.

All substitute forms must be submitted to DOR for approval. This includes a form provider developing substitute forms and a software provider who purchases a set of forms used in developing tax preparation software. If you purchase forms from a forms developer, your substitute forms will not be approved until the forms developer has received approval. All providers using another developers forms must submit these forms for approval. A list of approved forms by provider will be posted on our web-page for your convenience.

The DOR strongly encourages providers to read and understand the guidelines detailed in this document prior to submitting any forms to the DOR for approval. Electronic submissions for approval are not accepted. You cannot e-mail or fax forms for approval, except as directed by the DOR. Submissions must be originals - photocopies will not be approved. The forms must be originals and will be tested with DOR scanning and imaging equipment as they will actually be processed in production when they are filed.

It may be required that Software providers submit their software for inspection, if after the forms are approved there is a problem with the forms that the taxpayers are submitting.

Requirements for Approval

All forms prepared by an external provider must be pre-approved by the DOR prior to distribution or use by the general public. The following requirements for any provider form must be met in order for a provider version of a DOR form to be approved.

Barcode Requirements

1. The barcode must be of type 2 of 5 interleaved.

2. The attached samples reflect the required position of the barcode. The barcode on the attached form is positioned 2" from the top and side edges of the page to accommodate printer variation.

3. Exact positioning of the barcode is required. The barcode is the first item on every form.

The barcode position is row 4, position 6 on a 10/6 grid. The top of the barcode occupies row 4, positions 6-20. The bottom of the barcode occupies row 6, positions 6-20.

4. Barcode size (height and width) must match the samples. The widths of the bars (black and white) must be at least the width of the sample barcodes enclosed. The width of the barcode must fall within the range of 1.47-1.5 inches (target is 294 mm). The height of the barcode must fall within the range of 0.47-0.50 inches (target is 88 mm). Exact positioning of the barcode is required.

5. Text in the barcode should be partially embedded (see forms). The form number must be printed in full on the form. (For example, Form Number 72-010-99-3-1-000.) The positioning of the printed form number must not violate the clearance requirements around the barcode (1/4 inch clearance).

6. The barcode number is a 12 digit number. The numbering methodology used by the DOR is the following:

  • 72 - Tax Division Prefix
  • 010 - Form Number
  • 99 - Year of Form
  • 3 - Version within the Year
  • 1 - Page Number
  • XXX - Provider Number - assigned to each software vendor by DOR

Example: Form 72-010-99-3-1-222 is for page 1 of the Sales Tax Long form, produced by the provider assigned the number 222.

Form numbers are provided on the forms posted on our web-page. The assigned provider number must be obtained from our Forms Coordinator at 601-923-7038. You should place the provider number assigned to your organization in the barcode on the sample forms submitted to DOR for approval. If you purchase forms from another software provider, your Provider Number must appear in the lower left corner of the forms. The form vendor's number remains in the barcode and full form number.

Registration Marks Requirements

1. The lines of the registration marks should be in the range of 3/8 to 2 inch in length and 0.04 inch (1 mm) in thickness. The length and thickness should match the sample forms provided on our webpage. Exact positioning of registration marks is required. Whenever possible, DOR has tried to standardize on registration marks of 2 inch in length and 1 mm in thickness.

2. The relative position of the top of the barcode and the registration marks cannot vary, as the locations of these three elements on the form are used to register and de-skew the image. Exact positioning of all elements (barcodes and registration marks) is required for all substitute forms.

The registration marks must be positioned as shown on the attached samples (2 inch from the edges of the page). A 1/4 inch clearance on all sides of the barcode is required.

A text anchor is used to insure that the form can be de-skewed when other de-skewing marks may fail. The position of this text anchor will be given in the Key to each form.

General Format Requirements

Original Forms

The DOR will only accept original provider returns. Photocopies or facsimiles of a return are not acceptable.

Taxpayer Signature

Signature of the taxpayer(s) on substitute or computer-generated forms must be the original signature. The taxpayer(s) must sign the return.

Layout

The layout and format of the forms should match the samples provided. Information cannot be shrunk or enlarged. The order of the data must not be changed. Exact positioning of the barcode, the registration marks and the data in the scanband cannot vary. A key is provided specifying the positioning of these elements, a description of the data in each field, and the formatting of the data. The remainder of the form should conform as closely as possible to the example provided, but it does not have to be exact. Forms that vary to the extent that they are difficult to use will be not be approved.

Grids

The substitute forms are laid out on the 10/6 grid to conform with NACTP standards. In some cases this means that a substitute form looks significantly different than the official DOR form (the drop-out ink form).

Scanband Requirements

The formatting information for the data fields is specified in the Key to the form. It must be followed exactly. Some general information that may be of assistance is as follows:

Font

The font must be Courier, 12 pt.

The provider versions of the forms are intended to be laser printed. Do not hand print data on these forms.

Required Data

All scanband forms are required to have data in all data positions in the scanband, except spouse's name field. All software developers should force all data fields in the scanband to have data. If it is a user defined field and the user leaves the data field blank, force a zero (0) in numeric field or an (N) in an alpha field. In the body of the form unless a specific line instruction requires a zero (0), leave the line blank when there is no entry. For example, if there is no spouse, in the scanband leave the spouse's name field blank, but have a zero (0) in the SSN field.

SSN, FEIN or Other Account Number

The account number formatting is specified in the key to the form. This must be followed exactly. Some account number will be formatted with a check digit. This check digit is to be calculated using Modulus 10 Self-check Digit Computation. See Appendix B for this computation.

Money Amounts

The amounts in the scanband should not contain any commas, cents, decimals or other formatting information except for a negative sign (-) as a leading indicator for any negative amount. The negative indicator should immediately precede the first numeric character in the field. Negative indicators should only be used when an amount can be either positive or negative. All money amounts should be rounded to the nearest dollar. None should include cents.

Filing Periods

The filing period must be numeric, and formatted as specified in the key to the form.

Other Data

The formatting information for other data fields is specified in the key to the form.

Requirements for the Body of the Form

Font

The font for the body of the form, must be Arial. Variable data should be the same as used in the scanband.

Required Data

Unless a specific line instruction requires a zero (0), leave the line blank when there is no entry. For example, if there is no spouse, leave the SSN field blank.

Schedules

Unless specifically stated for a return, if a taxpayer does not use a schedule, the schedule should not be submitted. If only one page of a schedule is used and it is a two page schedule both pages must be submitted with the return.

SSN

The SSN must be eleven characters (9 digits and two >-=). Enter 000-00-0000 in the SSN field if an individual has applied for or does not have an SSN.​​

FEIN

The FEIN must be ten characters (9 digits and one >-=). Enter 00-0000000 in the SSN field if an individual has applied for or does not have a FEIN.

Commas

Commas should be used for the ease of reading.

Cents Indicators

The money amounts in the body of the form are required to be rounded to the nearest whole dollar.

Rounding

Providers are required to round so that the amount reflected in the body of the form matches the amount in the scanband of that form.

Negative Indicators

For fields that have a negative indicator, a minus (-) sign should be included with the value on the form. For example, on the Individual Income Tax form 80-105, which requires rounding to the nearest whole dollar, a loss of $124.78 would be entered as -125 on the return. Brackets or parentheses () are not acceptable.

Filing Periods

The format for the filing period may be written out for ease of use in the body of the form.

Example

0700 in the scanband may appear as July, 2000 in the body of the form.

Other Requirements

Printing

Returns should be printed on high quality 20 lb. white bond paper.

Print using a laser printer. Handprint is not acceptable.

All forms must be simplex (single-sided) printed (no double sided forms).

All returns submitted must be originals. Photocopies of a return are not acceptable.

Form size

Form size is standard 8.5" x 11" unless otherwise specified. All 8 2" x 11" forms have a 2" margin (top, bottom, right and left).

Forms that are specified as coupon size include a line at the bottom indicating where the taxpayer must clip the return before mailing the return and payment. Failure to clip the return to the correct size may result in a penalty to the taxpayer. Please include this requirement in the instructions you provide to the taxpayer.

All coupon size form must have data in all data field and check boxes in order to be approved.

Ink color

Ink color is black, non-MICR ink only. No shaded (or screened) printing should appear on a substitute form.

Instructions

Instructions furnished by DOR should be provided to the taxpayer. Do not submit instructions provided by DOR back to DOR for approval.

Additional Information

Several providers add their own internal numbers to the forms. This practice is acceptable as long as the numbers do not interfere with data capture fields or registration marks (must be 1/4" clearance from a registration mark or barcode or any data capture field).

If a form is purchased by a provider (for example, a provider buys a form created by Nelco), Nelco's provider number should appear in the barcode, and the other provider's number should be printed near the bottom left of the form (but maintain the 1/4 inch clearance around the lower left registration mark).​​

Approval Process

The substitute forms approval process is as follows:

The DOR provider guidelines and forms packets are posted on the DOR web-site. The forms packets can be downloaded and printed as Adobe Acrobat 3.0 ("filename.PDF") files. You must have a UserID and Password to access the Provider Forms Packets. If you do not have a UserID and Password, contact the Forms Coordinator to place your request for a UserID and Password.

UserIDs and Password may be inactivated in August of each year before the Individual Income Tax forms are posted to the webpage. Providers must submit information requested in a Provider Notice that will be mailed to the address the provider used the previous year, unless we have received a change of address notification.

Provider Forms Packets will only be mailed upon request. If you have questions about the provider forms, please check our message board on the web site first before calling the Forms Coordinator. If you still have questions after checking the message board, please call the Forms Coordinator at (601) 923-7038. Each provider form packet contains the following information:

The provider version of the form with variable data boxes indicated by dashed line boxes and labels indicating where the data is located in the body of the form. Do not submit forms with these dashed lines. The dashed lines are for your reference and should not appear on the forms you submit for approval.

The provider version of the form with variable data boxes indicated by dashed line boxes and the beginning and the ending grid position of each data field.

The provider version of the form with example data entered on the form. Providers should produce their data from their software and submit the five (5) sample returns. Most forms packets contain one example. More complex forms (Sales Tax long form, Individual Income) may contain more than one examples. In these cases, all the examples should have a set of 5 returns submitted for approval.

Any instructions for the return. Instructions are for your reference only. Instructions do not need to be submitted to DOR for approval. You should give any instructions to the taxpayer for informational purposes.

Any additional requirements. (For example, how to indicate a zero return or if the form size is a coupon and must be clipped to a specific size, rounding to whole dollars.)

2. The provider sends a submission packet for approval. Providers may submit all related forms as one submission. For example, the provider should submit all Sales tax forms for which approval is needed in one submission. This will expedite the approval process.

The provider's submission must include the following:

One (1) original sample of each form to DOR with no data entered (all fields blank). Do not print dashed line boxes on the return.

Five (5) printed original samples of each form for testing and approval. The five (5) sample forms should use data that you provided from your software. Photocopies of FAX submissions of a return are not acceptable, except as instructed by the Forms Coordinator. Mail your submission including one original form (no data) and the five (5) samples of each form with the variable data fields completed to:

Mississippi Department of Revenue
Attn: Forms Coordinator
500 Clinton Center Drive
Clinton, MS 39056

Deadlines for Submissions

Income Tax forms (Withholding, Individual and Corporate) shall be submitted by December 1st of each year. All forms submitted prior to December 1st will take top priority, after December 1st form will be turned around with in the NACTP guidelines.

Sales Tax forms may be submitted at any time for tax year.

Software providers may be required that they submit their software for inspection, if after the forms are approved there is a problem with the forms that the taxpayers are submitting.

3. Upon receipt, the DOR tests each form for barcode, registration, de-skewing, and read rate on all the data capture fields. If the form is acceptable, it is approved. After review, the provider will be notified by fax as to whether the form(s) has been approved, a fax number should be submitted with each submission. A letter of approval or disapproval will be issued on all proposed forms. Approvals are valid for one year only.​​

DOR will try to respond to requests within 10 business days of receipt of the provider's forms. We encourage and welcome any questions and/or feedback you can provide us on how to simplify and improve this process.

Note that if a form is not approved, and a taxpayer submits the unapproved form to the DOR, the taxpayer, provider, and/or preparer may be penalized for submissions of an unapproved form.

If you have questions, or need forms, please contact the Forms Coordinator at (601) 923-7038.

APPENDIX A - Sample of Form Key to Data Fields

Key to Data Fields for the Resident Individual Income Tax Form for 1999

Key to the data fields for the income tax long form scanband version for 1999. The form number is 80-105-99.

Page 1:

The top left corner of the barcode is located at position x=6, y=4 on the 10/6 grid.

The top right registration mark is located at the top right corner of grid box x=80, y=4.

The lower left corner of the scanband must be located on the left and bottom edge of grid space x=6, y=22.

"MS" to the left of the header must begin in grid space 27/4 and end in grid space 28/4 and be in an Courier 12 pt.

The "IS B" in the right hand corner should be at grids 72/5 to 75/5 and be in an Arial 18 pt.

Page 2:

The top left corner of the barcode is located at position x=6, y=4 on the 10/6 grid.

The top right registration mark is located at the top right corner of grid box x=80, y=4.

The lower left corner of the scanband must be located on the left and bottom edge of grid space x=6, y=19.

"MS" to the left of the header must begin in grid space 27/4 and end in grid space 28/4 and be in an Arial 12 pt.

The following is the labeling and the description of the items to be included in the Scanband of this form. The beginning and ending data positions are included in one of the templates for the form The field length is included in this key for each data position. Grid positioning give is from the first grid space to the last grid space included in a data field. (Example 22/9 to 29/9 is 8 grid spaces) You should use this information to position the data on the returns. Do not use a grid overlay to determine the positions from a printed paper form. The field length specified assumes using a Courier 12 point font, which is the required font. In the Scanband, the name and address fields should be left justified. All other fields should be right justified. All fields in the scanband must be filled, except the spouses name field. If a field is Blank in the scanband, your software should fill the field using a "0" (zero) for numeric fields and an "N" for alpha or alphanumeric fields. The money field in the scanband should not contain any commas, cents, decimals or other formatting information except for the negative signs (-) as a leading indicator for any negative amount. The amounts in the body of the return should contain commas. Example -123,456 in the body of the form would appear as -123456 in the scanband.

Front (Page 1) of the form:

For Official Use Only Boxes: The top left corner of the "Official Use Only" boxes should begin at position 58/6.

Box 1 - If the taxpayer has a Mississippi address, enter the number of the Resident County Code for the county in which the taxpayer is located in a 14 point Arial font. If the taxpayer has a non-Mississippi address, enter "90" as the county code in a 14 point Arial font.

Box 2 - Enter the number of the filing status (1 through 5) in a 14 point Arial font.

Box 3 - Enter the number of dependents claimed in a 14 point Arial font. If zero, enter "0".

Box 4 - Leave blank.

Field Name Description

AC This field indicates that the Taxpayers address has changed. This field should be Y or N in the scanband. X or blank in the body of the form. This field is one character long. Data begins and ends at grid 8/9.

RC Resident County Code - This code is a numeric field with the codes ranging from 01 to 82. These codes are found in the instructions to the taxpayer for this form. This field is two characters long. Data begins at grid 12/9 and ends at grid 13/9.

FS Filing Status - This field is a numeric field ranging from 1 to 5. In the scanband the number is entered in the field. In the body of the return an X is placed in the appropriate box. This field is one character long. Data begins and ends at grid 13/10.

7A,7C These fields indicate that the Taxpayer or the Spouse of the taxpayer is 65 years of age or older.​​

These fields should be Y or N in the scanband. X or blank in the body of form. These fields are each one character long. Data begins and ends at grid 8/10 and 8/12 respectively.

7B,7D These fields indicate that the Taxpayer or the Spouse of the taxpayer is Blind. These field should be Y or N in the scanband. X or blank in the body of form. This field is one character long. Data begins and ends at grid 8/11 and 8/13.

8 This is a numeric field indicating the number of dependents listed on line 6 in the body of the return. In the scanband this number is either 1 or greater. In the body of the return the dependents are listed by name, social security number, and relationship to the taxpayer. The number of dependents listed should match the number in this field. This field is two characters long. Data begins at grid 12/11 and ends at 13/11.

9 This field is a numeric field indicating the number of Y in the scanband for items 7A - 7D or the number of X in line 7 of the body of the return. This numeric field will range from 1 to 4. This field is one character long. Date begins and ends at grid 13/12.

10 This field is to be zero unless the taxpayer's Filing Status (FS) field has a 4, then this field has a one (1) entered. This field is one character long. Data begins and ends at grid 13/13.

11 This is a numeric field. This field is two characters long. Data begins at grid 12/14 and ends at grid 13/14.

12 This is a numeric field that is a money field. This field is 9 characters long. Data begins at grid 16/9 and ends at grid 24/9.

13 This is a numeric field that is a money field. This field is 9 characters long. Data begins at grid 16/10 and ends at grid 24/10.

14 This is a numeric field and is a money field. This field is 9 characters long. Data begins at grid 16/11 and ends at grid 24/11.

15 This is a numeric field and is a money field. This field is 9 characters long. Data begins at grid 16/12 and ends at grid 24/12.

16A & 16B This is a numeric field and is a money field, "A" being the taxpayer's wages and "B" being the spouse's wages. These fields are each 9 characters long. Data begins and ends at grids 16/13 to 24/13 and 29/13 to 37/13.

17A & 17B This is a numeric field and is a money field, "A" being the taxpayer's Other Income and "B" being the spouse's other income. These fields are each 9 characters long. Data begins and ends at grids 16/14 to 24/14 and 29/14 to 37/14.

18A & 18B This is a numeric field and is a money field, "A" being the taxpayer's Adjustments to Gross Income, and "B" being the spouse's adjustments to gross income. These fields are each 9 characters long. Data begins and ends at grids16/15 to 24/15 and 29/15 to 37/15.

19A & 19B This is a numeric field and is a money field, "A" being the taxpayer's Mississippi Adjusted Gross Income and "B" being the spouse's Mississippi Adjusted Gross Income. These fields are each 9 characters long. Data begins and ends at grids 29/9 to 37/9 and 42/9 to 50/9.

20A & 20B This is a numeric field and is a money field, "A" being the taxpayer's Standard or Itemized Deduction and "B" being the spouse's standard or itemized deduction. These fields are 9 characters long. Data begins and ends at grids 29/10 to37/10 and 42/10 to 50/10.

21A & 21B This is a numeric field and is a money field, "A" being the taxpayer's exemption and "B" being the spouse's exemption. These fields are 9 characters long. Data begins and ends at grids 29/11 to 37/11 and 42/11 to 50/11.

22A & 22B This is a numeric field and is a money field, "A" being the taxpayer's Mississippi Taxable Income and "B" being the spouse's Mississippi Taxable Income. These fields are 9 characters long. Data begins and ends at grids 29/12 to 37/12 and 42/12 to 50/12

23 This is a numeric field and is a money field, Total Income Tax Due per the Schedule of Tax Computation. This field is 9 characters long. Data begins and ends at grids 42/13 to 50/13.

24 This is a number field and is a money field. Taxpayer provides information in this field per the W-2 or other documentation. This field is 9 characters long. Data begins and ends at grids 42/14 to 50/14.

25 This is a numeric field and a money field. Taxpayer provides information in this field per estimates paid or payment with extension. This field is 9 characters long. Data begins and ends at grids 42/15 to 50/15.

26 This is a numeric field and a money field. The taxpayer provides information in this field for tax paid to other states. This field is 9 characters long. Data begins and ends at grids 55/9 to 63/9.

27 This is a numeric field and a money field. The taxpayer provides information tin this field for other tax credit allowed. This field is 9 characters long. Data begins and ends at grids 55/10 to 63/10.

28 This is a numeric field and a money field. This field is 9 characters long. Data begins and ends at grids 55/11 to 63/11.

29 This is a numeric field and a money field. This field is 9 characters long. Data begins and ends at grids 55/12 to 63/12.​​

30 This is a numeric field and a money field. This field is 9 characters long. Data begins and ends at grids 55/13 to 63/13.

31 & 32 This is a numeric field and a money field. This field is blank unless the taxpayer chooses to apply refund to these funds. These fields are 9 characters long. Data begins and ends at grids 55/14 to 63/14 and 55/15 to 63/15.

33 This is a numeric field and a money field. This field is 9 characters long. Data begins and ends at grids 69/9 to 77/9.

34 This is a numeric field and a money field. This field is 9 characters long. Data begins and ends at grids 69/10 to 77/10.

35 This is a numeric field and a money field. This field is 9 characters long. Data begins and ends at grids 69/11 to 77/11.

36 This is a numeric field and a money field. This field is blank unless the taxpayer fails to file his/her return on time. This field is 9 characters long. Data begins and ends at grids 69/12 to 77/12.

37 This is a numeric field and a money field. This field is 9 characters long. Data begins and ends at grids 69/13 to 77/13.

38 This is a numeric field and a money field. This field is 9 characters long. Data begins and ends at grids 69/14 to 77/14.

TS This is an alpha field. This is the taxpayer's Social Security Number. This field is 10 characters long. The last digit in this field is a check digit. This check digit is in the scanband but not in the body of the form. Check digits should be calculated using Modulus 10 Self-check Digit Computation found in Appendix B of this document. Data begins and ends at grids 68/15 to 77/15.

SS This is an alpha field. This is the spouse's Social Security Number. This field is 10 characters long. The last digit in this field is a check digit. This check digit is in the scanband but not in the body of the form. Check digits should be calculated using Modulus 10 Self-check Digit Computation found in in Appendix B of this document. Data begins and ends at grids 68/16 to 77/16.

TY This is a numeric field. This is the Tax Year being filed. This field is 4 characters long. Data begins and ends at grids 74/17 to 77/17.

N1 Taxpayer's last name. This is an alpha field. This field is 20 characters long. Data begins and ends at grids10/17 to29/17.

N2 Taxpayer's first name and middle initial. This is an alpha field. This field is 12 characters long .Data begins and ends at grids 32/17 to 43/17.

N3 Spouse's first name and middle initial. This is an alpha field. This field is 12 characters long. Data begins and ends at grids 46/17 to 57/17. This field may be left blank if there is no spouse.

A Taxpayer's current address. This is an alpha and numeric field. This field is 28 characters long. Data begins and ends at grids 10/19 to 37/19.

C1 Taxpayer's city of residency. This is an alpha field. This field is 12 characters long. Data begins and ends at grids 10/21 to 21/21. The field is 12 characters long. Data begins and ends at grids 55/9 to 63/9.

C2 Taxpayer's state of residency. This is an alpha field and contains the state two letter abbreviation of the taxpayer's residency. This field is 2 characters long. Data begins and ends at grids 24/21 to 25/21.

C3 Taxpayer's Zip Code. This is a numeric field and contains the taxpayer's zip code (Zip plus 4). If you do not have the plus 4, leave that portion blank and only enter the 5 digit Zip Code. This field is 10 characters long. Data begins and ends at grids 28/21 to 37/21.

Back (Page 2) of the Form:

Field Name Description

All Grid Positions are on page 6 of this Package. Use Courier 12pt. and all fields must be filled.

39A to 48B This is a numeric field and is a money field. Column "A" is the taxpayer's Income and Column "B" is the spouse's income. These field are 9 characters long.

49A to 56B This is a numeric field and is a money field. Column "A" is the taxpayers Adjustments and Column "B" is the spouse's Adjustments. These field are 9 characters long.

AR This is a numeric field and is the Social Security number of the recipient of Alimony Paid by the taxpayer. This field is 9 characters long.

AS This is an alpha field and is the state of residency of the recipient of Alimony Paid by the taxpayer. This field is 2 characters long.

PF This is a numeric field and is the Paid Firm's Identification Number. This field is 9 characters long.

PS This is a numeric field and is the Paid Preparer's Social Security Number. This field is 9 characters long.

APPENDIX B - Modulus 10 Check Digit Calculation

Modulus 10 detects single transpositions and incorrect digits. The Modulus 10 check digit is obtained for the 9 digit account number in the following manner:

Multiply every other digit by two, starting with the first digit. (odd digits)

Add the individual digits produced by step 1 to the remaining (even) digits.

Subtract the step 2 total form the next higher multiple of 10.

Example:

9 Digit Account Number 1 2 3 4 5 6 7 8 9

Odd Digits of Number 1 3 5 7 9

Multiply By 2 x 2

_________________

Results 2 6 10 14 18

2 4 6 8

_________________

All Digits 2 2 6 4 10 6 14 8 18

Add Individual Digits 2+2+6+4+1+6+5+8+9=43

Next Higher Multiple of 10 50

Less Total -43

_________________

Check Digit 7

Account Number with Check Digit 1 2 3 4 5 6 7 8 9 -7

Appendix C

DOR will now allow certain forms to be submitted for approval by pdf. If the form does not contain a bar code, DOR will allow that form to be submitted in a pdf format. The pdf file should be e-mailed to the forms coordinator for approval. If the form contains a bar code, it should still be mailed to the DOR as an original paper form.

All forms will still be accepted as original paper forms. The approval process for all forms, paper and pdf, will remain the same.

If a form is submitted as a pdf file and should be sent as an original paper form, the form will be discarded and an e-mail will be sent to the software provider to submit an original form.

DOR reserves the right to refuse forms submitted in a pdf format if problems occur with the procedure. ​