If my wife is a nonresident under DACA, and I am a US citizen, filing jointly, how do we file her 1042-S, income code 15, early 401K withdrawal as a substitute 1099-R?

I just need to know which details to put where. I am given the gross income, tax percentage, tax withholding amount, and the EIN number for the withholding agent. I dont know where to put these into the 1099-R substitute.