How do I report excess 401k contribution? I have withdrawn the excess amount: one is for the excess deferral and another for the income attributed to the excess deferral

I will receive 2x 1099-R forms by Jan 2023 but don't have that information yet to report it on my current tax year.
It seems that I need to fill in a 1099-R to the best of my knowledge, my question is whether box 1 and 2a should be the excess deferral only or excess deferral and earned income.
In addition, how should I check the state income taxes boxes on that 1099-R