8843 Statement for Exempt Individuals and Individuals With a

Form

8843

Statement for Exempt Individuals and Individuals
With a Medical Condition

Department of the Treasury
Internal Revenue Service

beginning

Go to www.irs.gov/Form8843 for the latest information.

For the year January 1—December 31, 2021, or other tax year
, 2021, and ending

Your first name and initial

Part I

2021

For use by alien individuals only.

▶

Fill in your
addresses only if
you are filing this
form by itself and
not with your tax
return

OMB No. 1545-0074

Last name
Address in country of residence

, 20

.

Attachment
Sequence No. 102

Your U.S. taxpayer identification number, if any
Address in the United States

General Information

1a Type of U.S. visa (for example, F, J, M, Q, etc.) and date you entered the United States ▶
b Current nonimmigrant status. If your status has changed, also enter date of change and previous status. See instructions.
2
3a
b
4a

Of what country or countries were you a citizen during the tax year?
What country or countries issued you a passport?
Enter your passport number(s) ▶
Enter the actual number of days you were present in the United States during:
2021
2020
2019
b Enter the number of days in 2021 you claim you can exclude for purposes of the substantial presence test

Part II

▶

Teachers and Trainees

5

For teachers, enter the name, address, and telephone number of the academic institution where you taught in 2021 ▶

6

For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program
you participated in during 2021 ▶

7

Enter the type of U.S. visa (J or Q) you held during: ▶
2015
2016
. If the type of visa you held during any
2017
2018
2019
2020
of these years changed, attach a statement showing the new visa type and the date it was acquired.
Were you present in the United States as a teacher, trainee, or student for any part of 2 of the 6 prior
calendar years (2015 through 2020)? . . . . . . . . . . . . . . . . . . . . . . . .
Yes
If you checked the “Yes” box on line 8, you cannot exclude days of presence as a teacher or trainee unless
you meet the Exception explained in the instructions.

8

Part III
9

No

Students

Enter the name, address, and telephone number of the academic institution you attended during 2021

▶

10

Enter the name, address, and telephone number of the director of the academic or other specialized program you participated
in during 2021 ▶

11

Enter the type of U.S. visa (F, J, M, or Q) you held during: ▶
2015
2016
. If the type of visa you held during any
2017
2018
2019
2020
of these years changed, attach a statement showing the new visa type and the date it was acquired.
Were you present in the United States as a teacher, trainee, or student for any part of more than 5 calendar
years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
If you checked the “Yes” box on line 12, you must provide sufficient facts on an attached statement to
establish that you do not intend to reside permanently in the United States.

12

13

14

During 2021, did you apply for, or take other affirmative steps to apply for, lawful permanent resident status
in the United States or have an application pending to change your status to that of a lawful permanent
resident of the United States? . . . . . . . . . . . . . . . . . . . . . . . . . .
If you checked the “Yes” box on line 13, explain ▶

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 17227H

Yes

No

No

Form 8843 (2021)

Page 2

Form 8843 (2021)

Part IV

Professional Athletes

15

Enter the name of the charitable sports event(s) in the United States in which you competed during 2021 and the dates of
competition ▶

16

Enter the name(s) and employer identification number(s) of the charitable organization(s) that benefited from the sports
event(s) ▶

Note: You must attach a statement to verify that all of the net proceeds of the sports event(s) were contributed to the charitable
organization(s) listed on line 16.

Part V
17a

Individuals With a Medical Condition or Medical Problem

Describe the medical condition or medical problem that prevented you from leaving the United States.
See instructions. ▶

b Enter the date you intended to leave the United States prior to the onset of the medical condition or medical problem described
on line 17a ▶
c
18

Enter the date you actually left the United States ▶
Physician’s Statement:
I certify that
Name of taxpayer

was unable to leave the United States on the date shown on line 17b because of the medical condition or medical problem
described on line 17a and there was no indication that his or her condition or problem was preexisting.

Name of physician or other medical official

Physician’s or other medical official’s address and telephone number

Date

Physician’s or other medical official’s signature

Under penalties of perjury, I declare that I have examined this form and the accompanying attachments, and, to the best of my knowledge and belief,
they are true, correct, and complete.

Your signature

▲

▲

Sign here
only if you
are filing
this form by
itself and
not with
your tax
return

Date
Form 8843 (2021)

Page 3

Form 8843 (2021)

General Instructions
Section references are to the Internal
Revenue Code unless otherwise specified.

Future Developments
For the latest information about
developments related to Form 8843 and its
instructions, such as legislation enacted
after they were published, go to
www.irs.gov/Form8843.

What’s New
COVID-19 Medical Condition Travel
Exception (Rev. Proc. 2020-20
Exception). For tax year 2021, individuals
cannot claim the COVID-19 medical
condition travel exception to exclude any
days of presence in the United States for
the purpose of the “substantial presence
test.” However, days of presence in the
United States in 2020 that were excluded
for tax year 2020 may impact the
application of the “substantial presence
test” for tax year 2021. For more
information, see Days of presence in the
United States, later.

Who Must File
If you are an alien individual (other than a
foreign government-related individual), you
must file Form 8843 to explain the basis of
your claim that you can exclude days of
presence in the United States for purposes
of the substantial presence test because
you:
• Were an exempt individual, or
• Were unable to leave the United States
because of a medical condition or medical
problem.

When and Where To File
If you are filing a 2021 Form 1040-NR,
attach Form 8843 to it. Mail your tax return
by the due date (including extensions) to
the address shown in your tax return
instructions.
If you don’t have to file a 2021 tax return,
mail Form 8843 to the Department of the
Treasury, Internal Revenue Service Center,
Austin, TX 73301-0215 by the due date
(including extensions) for filing Form
1040-NR.

Penalty for Not Filing Form 8843
If you don’t file Form 8843 on time, you
may not exclude the days you were
present in the United States as a
professional athlete or because of a
medical condition or medical problem that
arose while you were in the United States.
Failure to exclude days of presence in the
United States could result in your being
considered a U.S. resident under the
substantial presence test.
You won’t be penalized if you can show
by clear and convincing evidence that you
took reasonable actions to become aware
of the filing requirements and significant
steps to comply with those requirements.

Substantial Presence Test
You are considered a U.S. resident if you
meet the substantial presence test for
2021. You meet this test if you were
physically present in the United States for
at least:
• 31 days during 2021; and
• 183 days during the period 2021, 2020,
and 2019, counting all the days of physical
presence in 2021 but only 1/3 the number
of days of presence in 2020 and only 1/6
the number of days in 2019.
Note: To claim the closer connection to a
foreign country(ies) exception to the
substantial presence test described in
Regulations section 301.7701(b)-2, you
must file Form 8840.
Days of presence in the United States.
Generally, you are treated as being present
in the United States on any day that you
are physically present in the country at any
time during the day. However, you don’t
count the following days of presence in the
United States for purposes of the
substantial presence test.
1. Days you regularly commuted to work
in the United States from a residence in
Canada or Mexico.
2. Days you were in the United States for
less than 24 hours when you were traveling
between two places outside the United
States.
3. Days you were temporarily in the
United States as a regular crew member of
a foreign vessel engaged in transportation
between the United States and a foreign
country or a possession of the United
States unless you otherwise engaged in
trade or business on such a day.
4. Days you were unable to leave the
United States because of a medical
condition or medical problem that arose
while you were in the United States.
5. Days you were an exempt individual.
Note: For more information on determining
resident alien or nonresident alien status
under the “substantial presence test” as a
result of having applied the COVID-19
Medical Condition Travel Exception to
exclude days of presence in the United
States in 2020, see Rev. Proc. 2020-20,
2020-20 I.R.B. 801, available at www.irs.
gov/irb/2020-20_IRB#REV-PROC-2020-20.

Exempt Individuals
For purposes of the substantial presence
test, an exempt individual includes anyone
in the following categories.
• A teacher or trainee (defined on this
page).
• A student (defined on the next page).
• A professional athlete temporarily present
in the United States to compete in a
charitable sports event.

The term “exempt individual” also
includes an individual temporarily present
in the United States as a foreign
government-related individual under an “A”
or “G” visa, other than individuals holding
“A-3” or “G-5” class visas. An individual
present under an “A-3” or “G-5” class visa
is not considered a foreign governmentrelated individual and must count all his or
her days of presence in the United States
for purposes of the substantial presence
test. For more details, see Pub. 519. If you
are present under any other “A” or “G”
class visa, you are not required to file Form
8843.

Specific Instructions
Part I—General Information
If you are attaching Form 8843 to Form
1040-NR, you aren’t required to complete
lines 1a through 4a of Form 8843 if you
provide the requested information on the
corresponding lines of Form 1040-NR. See
Schedule OI of those forms.
In this case, enter “Information provided
on Form 1040-NR” on line 1a of Form
8843. Complete line 4b and the rest of
Form 8843.
If Form 8843 is filed separately, you must
complete all entries on the form.
Line 1b. Enter your current nonimmigrant
status, such as that shown on your current
Immigration Form I-94, Arrival-Departure
Record. If your status has changed while in
the United States, enter the date of change
and previous status.

Part II—Teachers and Trainees
A teacher or trainee is an individual who is
temporarily present in the United States
under a “J” or “Q” visa (other than as a
student) and who substantially complies
with the requirements of the visa.
If you were a teacher or trainee under a
“J” or “Q” visa, you are considered to have
substantially complied with the visa
requirements if you haven’t engaged in
activities that are prohibited by U.S.
immigration laws that could result in the
loss of your “J” or “Q” visa status.
Even if you meet these requirements,
you can’t exclude days of presence in 2021
as a teacher or trainee if you were exempt
as a teacher, trainee, or student for any
part of 2 of the 6 prior calendar years. But
see the Exception below.
If you qualify to exclude days of
presence as a teacher or trainee, complete
Parts I and II of Form 8843. If you have a
“Q” visa, complete Part I and only lines 6
through 8 of Part II. On line 6, enter the
name, address, and telephone number of
the director of the cultural exchange
program in which you participated.

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Form 8843 (2021)

Exception. If you were exempt as a
teacher, trainee, or student for any part of 2
of the 6 prior calendar years, you can
exclude days of presence in 2021 as a
teacher or trainee only if all four of the
following apply.
1. You were exempt as a teacher,
trainee, or student for any part of 3 (or
fewer) of the 6 prior calendar years.
2. A foreign employer paid all your
compensation during 2021.
3. You were present in the United States
as a teacher or trainee in any of the 6 prior
years.
4. A foreign employer paid all of your
compensation during each of those prior 6
years you were present in the United
States as a teacher or trainee.
For more details, see Pub. 519.
If you meet this exception, you must
attach information to verify that a foreign
employer paid all the compensation you
received in 2021 and all prior years that
you were present in the United States as a
teacher or trainee.

Part III—Students
A student is an individual who is
temporarily present in the United States
under an “F,” “J,” “M,” or “Q” visa and who
substantially complies with the
requirements of the visa.
If you were a student under an “F,” “J,”
“M,” or “Q” visa, you are considered to
have substantially complied with the visa
requirements if you haven’t engaged in
activities that are prohibited by U.S.
immigration laws and could result in the
loss of your visa status.
Even if you meet these requirements,
you can’t exclude days of presence in 2021
as a student if you were exempt as a
teacher, trainee, or student for any part of
more than 5 calendar years unless you
establish that you don’t intend to reside
permanently in the United States. The facts
and circumstances to be considered in
determining if you have established that
you don’t intend to reside permanently in
the United States include, but aren’t limited
to:

1. Whether you have maintained a closer
connection to a foreign country than to the
United States (for details, see Pub. 519),
and
2. Whether you have taken affirmative
steps to change your status from
nonimmigrant to lawful permanent resident.
If you qualify to exclude days of
presence as a student, complete Parts I
and III of Form 8843. If you have a “Q”
visa, complete Part I and only lines 10
through 14 of Part III. On line 10, enter the
name, address, and telephone number of
the director of the cultural exchange
program in which you participated.

Part IV—Professional Athletes
A professional athlete is an individual who
is temporarily present in the United States
to compete in a charitable sports event.
For details on charitable sports events, see
Pub. 519.
If you qualify to exclude days of
presence as a professional athlete,
complete Parts I and IV of Form 8843.

Part V—Individuals With a Medical
Condition or Medical Problem
For purposes of the substantial presence
test, don’t count the days you intended to
leave the United States but couldn’t do so
because of a medical condition or medical
problem that arose while you were in the
United States. Whether you intended to
leave the United States on a particular day
is determined based on all the facts and
circumstances. For more details, see Pub.
519.
If you qualify to exclude days of
presence because of a medical condition
or medical problem, complete Part I and
lines 17a through 17c of Part V. Have your
physician or other medical official complete
line 18.
Note: You cannot exclude any days of
presence in the United States under any of
the following circumstances.

• You were initially prevented from leaving,
were then able to leave, but remained in
the United States beyond a reasonable
period for making arrangements to leave.
• You entered or returned to the United
States for medical treatment. It does not
matter whether you intended to leave the
United States immediately after the
medical treatment but couldn’t do so
because of unforeseen complications from
the medical treatment.
• The medical condition existed before
your arrival in the United States and you
were aware of the condition. It does not
matter whether you needed treatment for
the condition when you entered the United
States.
Paperwork Reduction Act Notice. We
ask for the information on this form to carry
out the Internal Revenue laws of the United
States. Section 7701(b) and its regulations
require that you give us the information.
We need it to determine if you can exclude
days of presence in the United States for
purposes of the substantial presence test.
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 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.