Form 673 Statement for Claiming Exemption from Withholding on For

Form

673

(Rev. August 2019)
Department of the Treasury
Internal Revenue Service

Statement for Claiming Exemption From Withholding
on Foreign Earned Income Eligible for the Exclusion(s)
Provided by Section 911
▶

OMB No. 1545-0074

Go to www.irs.gov/Form673 for the latest information.

The following statement, when completed and furnished by a citizen of the United States to his or her employer, permits the employer
to exclude from income tax withholding all or a part of the wages paid for services performed outside the United States.
Your first name and initial

Part I

Last name

Your social security number

Qualification Information for Foreign Earned Income Exclusion

I expect to qualify for the foreign earned income exclusion under either the bona fide residence or physical presence test for
.
calendar year
or other tax year beginning
and ending

Please check applicable box:
Bona Fide Residence Test
I am a citizen of the United States. I have been a bona fide resident of and my tax home has been located in
(foreign country or countries) for an uninterrupted
period which includes an entire tax year that began on
, 20
.
(date)
I expect to remain a bona fide resident and retain my tax home in a foreign country (or countries) until the end of the tax year for
which this statement is made. Or, if not that period, from the date of this statement until
, 20
.
(date within tax year)
I have not submitted a statement to the authorities of any foreign country named above that I am not a resident of that country.
Or, if I made such a statement, the authorities of that country thereafter made a determination to the effect that I am a resident of
that country.
Based on the facts in my case, I have good reason to believe that for this period of foreign residence I will satisfy the tax home
and the bona fide foreign resident requirements prescribed by section 911(d)(1)(A) of the Internal Revenue Code and qualify for the
exclusion Code section 911(a) allows.

Physical Presence Test
I am a citizen of the United States. Except for occasional absences that will not disqualify me for the benefit of section
911(a) of the Internal Revenue Code, I expect to be present in and maintain my tax home in
period that includes the entire tax year
on
, 20

(foreign country or countries) for a 12-month
. Or, if not the entire year, for the part of the tax year beginning
, and ending on
, 20
.

Based on the facts in my case, I have good reason to believe that for this period of presence in a foreign country or
countries, I will satisfy the tax home and the 330 full-day requirements within a 12-month period under section 911(d)(1)(B).

Part II
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Estimated Housing Cost Amount for Foreign Housing Exclusion (see instructions)

Rent . . . . . . . . . . . . . . . . . . . . . .
Utilities (other than telephone charges) . . . . . . . . . . .
Real and personal property insurance . . . . . . . . . . .
Occupancy tax not deductible under section 164 . . . . . . . .
Nonrefundable fees paid for securing a leasehold
. . . . . . .
Household repairs . . . . . . . . . . . . . . . . . .
Estimated qualified housing expenses. Add lines 1 through 6 . . .
Estimated base housing amount for qualifying period . . . . . .
Subtract line 8 from line 7. This is your estimated housing cost amount

Part III

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Certification

Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and
belief it is true, correct, and complete. I further certify under penalties of perjury that:
• The estimated housing cost amount entered in Part II, plus the amount reported on any other statements outstanding with other
employers, is not more than my total estimated housing cost amount.
• If I become disqualified for the exclusions, I will immediately notify my employer and advise what part, if any, of the period for
which I am qualified.
I understand that any exemption from income tax withholding permitted by reason of furnishing this statement is not a
determination by the Internal Revenue Service that any amount paid to me for any services performed during the tax year is
excludable from gross income under the provisions of Code section 911(a).
Your Signature

For Paperwork Reduction Act Notice, see instructions.

Date

Cat. No. 10183Y

Form 673 (Rev. 8-2019)

Form 673 (Rev. 8-2019)

Page

2

Instructions

Information for Employer

Future Developments
For the latest information about developments related to Form
673 and its instructions, such as legislation enacted after they
were published, go to www.irs.gov/Form673.

Once you have received Form 673 completed by the employee,
you may discontinue withholding of U.S. income tax on those
wages that qualify for the exclusion(s). If for any reason you
believe the employee will not qualify for the exclusion(s), you
should disregard Form 673.

What’s New

Note: If you have questions about the exclusion(s), see
Pub. 54.

Service performed in a combat zone. For tax years beginning
after December 31, 2017, new rules regarding the tax home test
apply for certain individuals serving in a combat zone in support
of the U.S. Armed Forces. For more information, see the
Instructions for Form 2555.
Form 2555-EZ. After tax year 2018, the Form 2555-EZ won’t be
available to make the election to exclude foreign earned income
and the foreign housing cost amount. Beginning with tax year
2019, all taxpayers will be required to use the Form 2555 to
claim the foreign earned income exclusion.

Information for Employee
Give Form 673 to your U.S. employer to claim an exemption
from U.S. income tax withholding on wages earned abroad to
the extent of the foreign earned income exclusion and foreign
housing exclusion. Your employer will then withhold the correct
amount of federal income tax from your pay.
If you qualify for the foreign earned income exclusion or the
foreign housing exclusion or deduction, complete Form 2555.
You must attach the completed Form 2555 to your Form 1040
or Form 1040-SR to claim your exclusion or deduction.
Estimated housing cost amount. The amount of qualified
housing expenses eligible for the housing exclusion is limited
depending on the location of your foreign tax home. See Pub.
54 and the Instructions for Form 2555 for more details.

Paperwork Reduction Act Notice
We ask for the information on this form to carry out the Internal
Revenue laws of the United States. If you want to claim an
exemption from withholding, you’re required to give this form (or
similar statement) to your employer.
You aren’t required to provide the information requested on a
form that is subject to the Paperwork Reduction Act unless the
form displays a valid OMB control number. Books or records
relating to a form or its instructions must be retained as long as
their contents may become material in the administration of any
Internal Revenue law. Generally, tax returns and return
information are confidential, as required by Code section 6103.
The average time and expenses required to complete and file
this form will vary depending on individual circumstances. For
the estimated averages, see the instructions for your income tax
return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for your
income tax return.