Form 2555 EZ Foreign Earned Income Exclusion

Form

2555-EZ

OMB No. 1545-0074

Foreign Earned Income Exclusion

Department of the Treasury
Internal Revenue Service (99)

▶

See separate instructions.

▶

2011

Attachment
Sequence No. 34A

Attach to Form 1040.

Your social security number

Name shown on Form 1040

You May Use
This Form
If You:

Part I
1

• Are a U.S. citizen or a resident alien.
• Earned wages/salaries in a foreign country.
• Had total foreign earned income
of $92,900 or less.
• Are filing a calendar year return that covers
a 12-month period.

• Do not have self-employment income.

And You:

• Do not have business/moving expenses.
• Do not claim the foreign housing
exclusion or deduction.

Tests To See If You Can Take the Foreign Earned Income Exclusion

Bona Fide Residence Test
Were you a bona fide resident of a foreign country or countries for a period that includes an entire tax year
(see page 2 of the instructions)? . . . . . . . . . . . . . . . . . . . . . . . . .
• If you answered “Yes,” you meet this test. Fill in line 1b and then go to line 3.
• If you answered “No,” you do not meet this test. Go to line 2 to see if you meet the Physical Presence Test.
b Enter the date your bona fide residence began ▶
, and ended (see instructions) ▶

a

Yes

No

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2

Physical Presence Test
Were you physically present in a foreign country or countries for at least 330 full days during—
2011 or
. . . . . . . . . . . . .
any other period of 12 months in a row starting or ending in 2011?
• If you answered “Yes,” you meet this test. Fill in line 2b and then go to line 3.
• If you answered “No,” you do not meet this test. You cannot take the exclusion unless you meet the
Bona Fide Residence Test above.
through ▶
b The physical presence test is based on the 12-month period from ▶
a

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3

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No

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Tax Home Test. Was your tax home in a foreign country or countries throughout your period of bona fide
residence or physical presence, whichever applies? . . . . . . . . . . . . . . . . . . .
• If you answered “Yes,” you can take the exclusion. Complete Part II below and then go to page 2.
• If you answered “No,” you cannot take the exclusion. Do not file this form.

Part II

Yes

No

General Information

4 Your foreign address (including country)

6 Employer’s name

9
a
b
c
10a
b
c
d
11a

Yes

5 Your occupation

7 Employer’s U.S. address (including ZIP code) 8 Employer’s foreign address

Employer is (check any that apply):
A U.S. business . . . . . . . . . . . . . . . . . . . . . . . . . . .
A foreign business . . . . . . . . . . . . . . . . . . . . . . . . . .
Other (specify) ▶
If you filed Form 2555 or 2555-EZ after 1981, enter the last year you filed the form. ▶
If you did not file Form 2555 or 2555-EZ after 1981, check here ▶
and go to line 11a now.
Have you ever revoked the foreign earned income exclusion?
. . . . . . . . . . .
If you answered “Yes,” enter the tax year for which the revocation was effective. ▶
List your tax home(s) during 2011 and date(s) established. ▶

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Yes

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No

b Of what country are you a citizen/national? ▶
For Paperwork Reduction Act Notice, see the Form 1040 instructions.

Cat. No. 13272W

Form

2555-EZ

(2011)

Form 2555-EZ (2011)

Part III

Page

2

Days Present in the United States— Complete this part if you were in the
United States or its possessions during 2011.

12

(a) Date arrived in U.S.

Part IV

(d) Income earned in U.S.
on business (attach computation)

(c) Number of days
in U.S. on business

(b) Date left U.S.

Figure Your Foreign Earned Income Exclusion

13

Maximum foreign earned income exclusion

14

Enter the number of days in your qualifying period that fall within 2011

15

Did you enter 365 on line 14?
Yes. Enter “1.000.”
No. Divide line 14 by 365 and enter the result as
a decimal (rounded to at least three places).

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Multiply line 13 by line 15

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17

Enter, in U.S. dollars, the total foreign earned income you earned and received in 2011 (see
instructions). Be sure to include this amount on Form 1040, line 7 . . . . . . . . . . .

17

Foreign earned income exclusion. Enter the smaller of line 16 or line 17 here and in parentheses
on Form 1040, line 21. Next to the amount enter “2555-EZ.” On Form 1040, subtract this amount
from your income to arrive at total income on Form 1040, line 22 . . . . . . . . . . . ▶

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$92,900 00

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×

Form

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2555-EZ

(2011)