Your score, section by section
All four. Which section is dragging changes the answer more than the total does, so the total is worked out from these rather than asked for.
Your time
A retake is bought in hours. These two fields decide whether you can afford it.
What went wrong last time
This changes the answer more than any other field. A score that never got the hours and a score that stalled despite them need completely different retakes.
Where you stand
Attempts count against AAMC limits, and your application plan changes the answer more than anything else here.
Your answer
Put in a score and a target and the answer appears here.