1040-SS U.S. Self-Employment Tax Return (Including the Additiona

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Form

1040-SS

U.S. Self-Employment Tax Return

OMB No. 1545-0090

(Including the Refundable Child Tax Credit for Bona Fide Residents of Puerto Rico)

2021

Please type or print.

Department of the Treasury U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, or Puerto Rico
For the year Jan. 1–Dec. 31, 2021, or other tax year beginning
, 2021, and ending
, 20
Internal Revenue Service
Your first name and initial

Last name

Your social security number

If a joint return, spouse’s first name and initial

Last name

Spouse’s social security number

DRAFT AS OF
July 30, 2021
DO NOT FILE

Present home address (number, street, and apt. no., or rural route)
City, town or post office, commonwealth or territory, and ZIP code
Foreign country name

Foreign province/state/county

Foreign postal code

At any time during 2021, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency?

Part I
1

Yes

No

Total Tax and Credits

Filing status. Check the box for your filing status. See instructions.
Single
Married filing separately (MFS)
Head of household
Qualifying Widow(er)
Married filing jointly
If you checked the MFS box, enter spouse’s social security no. above and full name here ▶
Qualifying children. Complete only if you are a bona fide resident of Puerto Rico and you are claiming the refundable child tax
credit. See instructions. If more than four qualifying children, see instructions and check here . . . . . . . . . .

2

(a) First name

3
4
5a
b
6
7
8
9
10
11a
b
12
13
14a
b

Last name

(b) Child’s social security number

(c) Child’s relationship to you

Self-employment tax from Part V, line 12 . . . . . . . . . . . . . . . . . .
Household employment taxes (see instructions). Attach Schedule H (Form 1040) . . . . .
Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . .
Repayment of advance child tax credit (see instructions) . . . . . . . . . . . . .
Total tax. Add lines 3 through 5b. See instructions . . . . . . . . . . . . . . .
2021 estimated tax payments (see instructions) . . . . . . . . . .
7
Excess social security tax withheld (see instructions) . . . . . . . .
8
Refundable child tax credit from Part II, line 3 . . . . . . . . . . .
9
Health coverage tax credit. Attach Form 8885 . . . . . . . . . . .
10
Credit for qualified sick and family leave wages for leave taken before April 1, 2021 11a
Credit for qualified sick and family leave wages for leave taken after March 31, 2021 11b
Total payments and credits (see instructions) . . . . . . . . . . . . . . . .
If line 12 is more than line 6, subtract line 6 from line 12. This is the amount you overpaid . .
Amount of line 13 you want refunded to you. If Form 8888 is attached, check here . . . .
▶ c Type:
Checking
Savings
Routing number

.
.
.
.
.

.
.
.
.
.

3
4
5a
5b
6

.
.

.
.

12
13
14a

▶

16

▶

d Account number
15
16

15
Amount of line 13 you want applied to 2022 estimated tax . . . . . ▶
Amount you owe. If line 6 is more than line 12, subtract line 12 from line 6. See instructions

Third Party
Designee

Sign
Here

Paid
Preparer
Use Only

.

Yes. Complete the following.

No

Designee’s
Phone
Personal Identification
▶
▶
name
no. ▶
Number (PIN)
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
and belief, they are true, correct, and complete. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has
any knowledge.
If the IRS sent you an Identity Protection PIN,
Daytime phone number
Your signature
Date
enter it here
(see instructions) ▶
If the IRS sent your spouse an Identity Protection
Spouse’s signature. If a joint return, both must sign.
Date
PIN, enter it here
(see instructions) ▶
Print/Type preparer’s name
Preparer’s signature
Date
Check
if PTIN

▲

Joint return?
See instructions.
Keep a copy
for your records.

Do you want to allow another person to discuss this return with the IRS? See instructions.

.

self-employed
Firm’s name

▶

Firm’s address

▶

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice,
see instructions.

Firm’s EIN ▶
Phone no.
www.irs.gov/Form1040SS

Cat. No. 17184B

Form 1040-SS (2021)

Form 1040-SS (2021)

Part II

Page

2

Bona Fide Residents of Puerto Rico Claiming Refundable Child Tax Credit—See instructions.

Tip: Bona fide residents of Puerto Rico may claim the refundable child tax credit for one or more qualifying children.
1
Modified adjusted gross income . . . . . . . . . . . . . . . . . . . . . . .
1
2
Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3
Refundable child tax credit. Use the Refundable Child Tax Credit Worksheet in the instructions. Enter
the amount from line 20 of the worksheet here and on Part I, line 9 . . . . . . . . . . . .
3
Part III
Profit or Loss From Farming—See the Instructions for Schedule F (Form 1040).

DRAFT AS OF
July 30, 2021
DO NOT FILE

Name of proprietor

Social security number

Note: If you are filing a joint return and both you and your spouse had a profit or loss from a farming business, see Joint returns and
Business Owned and Operated by Spouses in the instructions for more information.
Section A—Farm Income—Cash Method
Complete Sections A and B. (Accrual method taxpayers, complete Sections B and C, and Section A, line 11.)
Don’t include sales of livestock held for draft, breeding, sport, or dairy purposes. See instructions.
1
Sales of livestock and other items you bought for resale . . . . . . .
1
2
Cost or other basis of livestock and other items reported on line 1 . . . .
2
3
Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . .
3
4
Sales of livestock, produce, grains, and other products you raised . . . . . . . . . . . .
4
5a Total cooperative distributions (Form(s) 1099-PATR)
5a
5b Taxable amount 5b
6
Agricultural program payments received
. . . . . . . . . . . . . . . . . . . .
6
7
Commodity Credit Corporation (CCC) loans reported under election (or forfeited) . . . . . . .
7
8
Crop insurance proceeds . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . . .
9
10
Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
Gross farm income. Add amounts in the right column for lines 3 through 10. If accrual method
11
taxpayer, enter the amount from Section C, line 50 . . . . . . . . . . . . . . . . ▶
11
Section B—Farm Expenses—Cash and Accrual Method
Don’t include personal or living expenses (such as taxes, insurance, or repairs on your home) that didn’t produce farm income.
Reduce the amount of your farm expenses by any reimbursements before entering the expenses below.
24
Labor hired . . . . . . .
24
12
Car and truck expenses
25
Pension and profit-sharing plans
25
(see instructions) . . . . .
12
13
Chemicals . . . . . . .
13
26
Rent or lease:
14
Conservation expenses . . .
14
a Vehicles, machinery, and
equipment . . . . . . . .
15
26a
15
Custom hire (machine work) . .
b Other (land, animals, etc.) . . .
26b
16
Depreciation and section 179
27
Repairs and maintenance . . .
27
expense deduction not claimed
elsewhere (attach Form 4562 if
28
Seeds and plants purchased . .
28
required) . . . . . . . .
16
29
Storage and warehousing
. .
29
30
Supplies purchased
. . . .
30
17
Employee benefit programs other
than on line 25 . . . . . .
31
Taxes . . . . . . . . .
31
17
18
Feed purchased . . . . . .
18
32
Utilities . . . . . . . . .
32
19
Fertilizers and lime . . . . .
19
33
Veterinary, breeding, and medicine 33
20
Freight and trucking . . . .
20
34
Other expenses (specify):
21
Gasoline, fuel, and oil . . . .
21
a
34a
22
Insurance (other than health) .
22
b
34b
23
Interest (see instructions):
c
34c
a Mortgage (paid to banks, etc.) .
23a
d
34d
b Other . . . . . . . . .
23b
e
34e
35
Total expenses. Add lines 12 through 34e . . . . . . . . . . . . . . . . . . . ▶
35
36
Net farm profit or (loss). Subtract line 35 from line 11. Enter the result here and on Part V, line 1a .
36
Form 1040-SS (2021)

Form 1040-SS (2021)

37
38a
39
40
41
42
43
44
45
46
47
48
49
50

Page

3

Section C—Farm Income—Accrual Method
Don’t include sales of livestock held for draft, breeding, sport, or dairy purposes on any of the lines below. See instructions.
Sales of livestock, produce, grains, and other products during the year . . . . . . . . . .
37
Total cooperative distributions (Form(s) 1099-PATR) 38a
38b Taxable amount 38b
Agricultural program payments received
. . . . . . . . . . . . . . . . . . . .
39
Commodity Credit Corporation (CCC) loans reported under election (or forfeited) . . . . . . .
40
Crop insurance proceeds . . . . . . . . . . . . . . . . . . . . . . . . .
41
Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . . .
42
43
Other farm income (specify)
Add lines 37, 38b, and 39 through 43
. . . . . . . . . . . . . . . . . . . . .
44
Inventory of livestock, produce, grains, and other products at the beginning of
the year . . . . . . . . . . . . . . . . . . . . . . .
45
Cost of livestock, produce, grains, and other products purchased during the year 46
Add lines 45 and 46 . . . . . . . . . . . . . . . . . . .
47
Inventory of livestock, produce, grains, and other products at the end of the year 48
Cost of livestock, produce, grains, and other products sold. Subtract line 48 from line 47* . . . .
49
Gross farm income. Subtract line 49 from line 44. Enter the result here and on Part III, line 11 . . ▶
50

DRAFT AS OF
July 30, 2021
DO NOT FILE

* If you use the unit-livestock-price method or the farm-price method of valuing inventory and the amount on line 48 is larger than the amount on line 47,
subtract line 47 from line 48. Enter the result on line 49. Add lines 44 and 49. Enter the total on line 50 and on Part III, line 11.

Part IV

Profit or Loss From Business (Sole Proprietorship)—See the Instructions for Schedule C (Form 1040).
Social security number

Name of proprietor

Note: If you are filing a joint return and both you and your spouse had a profit or loss from a business, see Joint returns and Business
Owned and Operated by Spouses in the instructions for more information.
Section A—Income
Gross receipts $
Less returns and allowances $
Balance ▶
1
1
2a Inventory at beginning of year . . . . . . . . . . . . . . . .
2a
b Purchases less cost of items withdrawn for personal use . . . . . . .
2b
c Cost of labor. Don’t include any amounts paid to yourself . . . . . . .
2c
d Materials and supplies . . . . . . . . . . . . . . . . . .
2d
e Other costs (attach statement) . . . . . . . . . . . . . . . .
2e
f Add lines 2a through 2e . . . . . . . . . . . . . . . . . .
2f
g Inventory at end of year . . . . . . . . . . . . . . . . . .
2g
h Cost of goods sold. Subtract line 2g from line 2f . . . . . . . . . . . . . . . . . .
2h
3
Gross profit. Subtract line 2h from line 1 . . . . . . . . . . . . . . . . . . . .
3
4
Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5
Gross income. Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . ▶
5
Section B—Expenses
6
Advertising . . . . . . .
6
18
Rent or lease:
a Vehicles, machinery, and equipment 18a
7
Car and truck expenses
(see instructions) . . . . .
7
b Other business property . . .
18b
8
Commissions and fees . . .
8
19
Repairs and maintenance . . .
19
9
Contract labor . . . . . .
9
20
Supplies (not included in Section A) 20
10
21
Taxes and licenses . . . . .
21
10
Depletion . . . . . . . .
22
Travel and meals:
11
Depreciation and section 179
a Travel . . . . . . . . .
22a
expense deduction not claimed
elsewhere (attach Form 4562 if
b Deductible meals . . . . .
22b
required) . . . . . . . .
11
23
Utilities . . . . . . . . .
23
24
Wages not included on line 2c .
24
12
Employee benefit programs (other
than on line 17) . . . . . .
12
25a Other expenses (list type and
amount):
13
Insurance (other than health) .
13
14
15
16
17
26
27

Interest on business indebtedness
(see instructions) . . . . .
14
Legal and professional services .
15
Office expense . . . . . .
16
b Total other expenses .
Pension and profit-sharing plans
17
Total expenses. Add lines 6 through 25b . . . . . . . . . . . . . . . . .
Net profit or (loss). Subtract line 26 from line 5. Enter the result here and on Part V, line 2 .

.
.
.

.
.
.

.
▶

.

25b
26
27
Form 1040-SS (2021)

Form 1040-SS (2021)

Part V

Page

4

Self-Employment Tax—If you had church employee income, see instructions before you begin.

Name of person with self-employment income

Social security number of person
with self-employment income ▶

Note: If you are filing a joint return and both you and your spouse had self-employment income, you must each complete a separate
Part V.
If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had
A
$400 or more of other net earnings from self-employment, check here and continue with Part V . . . . . . . . ▶
1a
b

2

3
4a

b
c
5a

b
6
7
8a

b
c
d
9
10
11
12

DRAFT AS OF
July 30, 2021
DO NOT FILE

Net farm profit or (loss) from Part III, line 36, and your distributive share from farm partnerships.
Note: Skip lines 1a and 1b if you use the farm optional method. See instructions . . . . . . .
If you received social security retirement or disability benefits, enter the amount of Conservation
Reserve Program payments included on Part III, line 6, plus your distributive share of these payments
from farm partnerships . . . . . . . . . . . . . . . . . . . . . . . . . .
Net nonfarm profit or (loss) from Part IV, line 27, and your distributive share from nonfarm
partnerships. Ministers and members of religious orders, see instructions for amounts to report on
this line. See instructions for other income to report. Note: Skip this line if you use the nonfarm
optional method. See instructions . . . . . . . . . . . . . . . . . . . . . . .
Combine lines 1a, 1b, and 2
. . . . . . . . . . . . . . . . . . . . . . . .
If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter the amount from line 3
Note: If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see
instructions.
If you elect one or both of the optional methods, enter the total of lines 2 and 4 of Part VI here . . .
Combine lines 4a and 4b. If less than $400, stop; you don’t owe self-employment tax. Exception. If
less than $400 and you had church employee income, enter -0- and continue . . . . . . . ▶
Enter your church employee income from Form(s) W-2, W-2AS, W-2CM,
W-2GU, W-2VI, or 499R-2/W-2PR. See instructions for the definition of church
employee income . . . . . . . . . . . . . . . . . . . .
5a
Multiply line 5a by 92.35% (0.9235). If less than $100, enter -0- . . . . . . . . . . . . .
Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . ▶
Maximum amount of combined wages and self-employment earnings subject to social security tax for
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total social security wages and tips from Form(s) W-2, W-2AS, W-2CM,
W-2GU, W-2VI, or 499R-2/W-2PR. If $142,800 or more, skip lines 8b through
10, and go to line 11 . . . . . . . . . . . . . . . . . . .
8a
Unreported tips subject to social security tax from Form 4137, line 10 (see
instructions) . . . . . . . . . . . . . . . . . . . . . .
8b
8c
Wages subject to social security tax from Form 8919, line 10 (see instructions)
Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . . . ▶
Multiply the smaller of line 6 or line 9 by 12.4% (0.124) . . . . . . . . . . . . . . . .
Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . .
Self-employment tax. Add lines 10 and 11. Enter here and on Part I, line 3 . . . . . . . . .

Part VI

1a

1b (

)

2
3
4a

4b
4c

5b
6

142,800

7

8d
9
10
11
12

Optional Methods To Figure Net Earnings—See instructions for limitations.

Note: If you are filing a joint return and both you and your spouse choose to use an optional method to figure net earnings, you must
each complete and attach a separate Part VI.
Farm Optional Method
5,880
1
1
Maximum income for optional methods . . . . . . . . . . . . . . . . . . . . .
2
2
Enter the smaller of: two-thirds ( /3) of gross farm income (Part III, line 11, plus your distributive share
from farm partnerships), but not less than zero; or $5,880. Also, include this amount on Part V, line
4b, above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
Nonfarm Optional Method
3
3
Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . .
2
4
Enter the smaller of: two-thirds ( /3) of gross nonfarm income (Part IV, line 5, plus your distributive
share from nonfarm partnerships), but not less than zero; or the amount on Part VI, line 3, above.
Also, include this amount on Part V, line 4b, above . . . . . . . . . . . . . . . . .
4
Form 1040-SS (2021)