Originally Posted by jhernandez137

It was the same way for me when filing. There are a couple of fields you must manually enter.

As for the form date as long as you got it from the link below its the correct one. Here are the notes for the "Edition Date'.

https://www.uscis.gov/i-821d

Edition Date

"06/04/14. A new edition of this form is coming soon. In the meantime, customers may file using the 06/04/14 edition. We will not accept previous editions. You can find the edition date at the bottom of the page on the form and instructions."