For vacancy number, just put "Hardship" (or "ERR", for those that want to do a standard ERR)
Title, series, and grade of vacancy: It should read "ATCS, AT-2152-XX", where XX is your facility level (D-L, to denote 4-12) and Terminal or Enroute (H or K respectively) so a Level 9 TRACON or Tower would read "ATCS, AT-2152-IH" and a Level 12 Center would read "ATCS, AT-2152-LK"
The facility you want to go TO, you would put the corresponding Level and Type (TO Chicago Center: ATCS, AT-2152-LK)
The facility you are transferring FROM would be your current Level and Type (FROM Milwaukee Tower/TRACON: ATCS, AT-2152-IH)