You should input your Form 1099R exactly as reported to you. The Internal Revenue Service does not permit you to deduct losses from your Roth IRA on a year-to-year basis, so the only way to deduct your losses is to close your Roth IRA accounts.
If there is no State withholding or other State information on your Form 1099R, then leave it blank. Run your Smart Review to see if any filing errors, then continue with your return preparation.
See below for information on reporting a loss on your tax return.
Loss on Roth IRA Tax Deduction
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