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Because I had no earned income I was ineligible to contribute to my Roth IRA in 2021.  However I contributed $3000 in December.  I withdrew the excess contribution in February of 2022.  The amount calculated by the brokerage was $2783.50 showing a loss of $216.50.  When doing the 1099-R what do I put in Box 1, the original $3000 or  the $2783.50?  What to I put in box 2a, a negative $216.50 (loss) or some other amount?  Do I put anything in box 3?  Do I put a check in the IRA/SEP/SIMPLE box?