U.S. Individual Income Tax Return Forms

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SCHEDULE C
(Form 1116)
(December 2021)

DRAFT AS OF
October 13, 2021
DO NOT FILE
Foreign Tax Redeterminations

For calendar year 20

Department of the Treasury
Internal Revenue Service
Name

, or other tax year beginning

, 20

, and ending

, 20

.

OMB No. 1545-0121

See separate instructions.
▶ Go to www.irs.gov/Form1116 for instructions and the latest information.
▶

Identifying number as shown
on page 1 of your tax return

Use a separate Schedule C (Form 1116) for each applicable category of income listed below. See instructions. Check only one box on each schedule.
a
Section 951A category income
Passive category income
Section 901(j) income
Lump-sum distributions
c
e
g
b
d
f
Foreign branch category income
General category income
Certain income re-sourced by treaty
h If box e is checked, enter the country code for the sanctioned country. See instructions . . . . . . . . . . . . . . . . . . ▶
i If box f is checked, enter the country code for the treaty country. See instructions . . . . . . . . . . . . . . . . . . . . ▶

Part I

Increase in Amount of Foreign Taxes Accrued (see instructions)

Enter redetermined amounts by payor for each separate relation back year (starting with the most recent) followed by a subtotal for each relation back year.
1. U.S. Tax Year of Taxpayer
to Which Tax Relates
(relation back year)
(MM/DD/YYYY)

2b. EIN or
Reference ID
Number of Payor

3. Country or U.S. Possession
to Which Tax Is Paid
(enter code—see instructions)

4. Date Additional
Foreign Tax Was Paid
(MM/DD/YYYY)

5. Foreign Tax Year
to Which Tax Relates
(MM/DD/YYYY)

(1)
(2)
(3)
(1)
(2)
(3)

A

B
6. Payor’s Income
Subject to Tax in the
Foreign Jurisdiction
(see instructions)

A

2a. Name of Payor
(see instructions)

7. Additional Tax
Accrued in
Local Currency in
Which the Tax Is Payable

8. Additional Tax
Accrued in
Functional Currency
of Payor

10. Additional Tax
Accrued in U.S. Dollars
(divide column 7
by column 9)

9. Conversion Rate
of Local Currency
to U.S. Dollars

11. U.S. Dollar Tax
of Payor Reported on
Original/Amended Return

12. Revised Tax Accrued
(add column 10
and column 11)

13. Check Box if
Contested Tax
(see instructions)

(1)
(2)
(3)

Subtotal by Relation Back Year of Taxpayer (add amounts in columns 10, 11, and 12) .
(1)
B (2)
(3)

.

▶

Subtotal by Relation Back Year of Taxpayer (add amounts in columns 10, 11, and 12) .

.

▶

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 1116.

Cat. No. 75187Q

Schedule C (Form 1116) (12-2021)

Schedule C (Form 1116) (12-2021)

Part II

DRAFT AS OF
October 13, 2021
DO NOT FILE

Page 2

Decrease in Amount of Foreign Taxes Paid or Accrued (see instructions)

Enter redetermined amounts by payor for each separate relation back year (starting with the most recent) followed by a subtotal for each relation back year.
1. U.S. Tax Year of Taxpayer
to Which Tax Relates
(relation back year)
(MM/DD/YYYY)

3. Country or U.S. Possession
From Which Tax Was
Refunded or Deemed Refunded
(enter code—see instructions)

2b. EIN or
Reference ID
Number of Payor

4. Date Foreign Tax
Was Refunded or
Deemed Refunded
(MM/DD/YYYY)
(see instructions)

5. Foreign Tax Year
to Which Tax Relates
(MM/DD/YYYY)

(1)
(2)
(3)
(1)
(2)
(3)

A

B
6. Payor’s Income
Subject to Tax in the
Foreign Jurisdiction
(see instructions)

A

2a. Name of Payor
(see instructions)

7. Tax Refunded
or Deemed Refunded
in Local Currency in
Which the Tax Is Payable

8. Refunded Amount
in Functional Currency
of Payor

10. Refunded Amount
in U.S. Dollars
(divide column 7
by column 9)

9. Conversion Rate
of Local Currency
to U.S. Dollars

11. U.S. Dollar Tax
of Payor Reported on
Original/Amended Return

12. Revised Tax
Paid or Accrued
(subtract column 10
from column 11)

13. Check Box if
Section 905(c)(2)
Two Year Rule
Applies
(see instructions)

(1)
(2)
(3)

Subtotal by Relation Back Year of Taxpayer (add amounts in columns 10, 11, and 12) .
(1)
B (2)
(3)

.

▶

Subtotal by Relation Back Year of Taxpayer (add amounts in columns 10, 11, and 12) .

.

▶

Part III

Change in Foreign Taxes Paid or Accrued

Enter the information below for the change to the total amount of foreign taxes paid or accrued and the foreign tax credits (FTCs) claimed for each relation back year.
1. Relation Back Year
(MM/DD/YYYY)

2. Redetermined Foreign Taxes
Paid or Accrued

3. Foreign Taxes Paid or Accrued
per Original/Amended Return

4. Amount of FTC Claimed
per Original/Amended Return

5. Amount of FTC Claimed
After Redetermination

A
B

Part IV

Change in U.S. Tax Liability

Enter the information below for the change in U.S. tax liability for each relation back year and other affected year (see instructions).
1. Relation Back Year or Affected Tax Year
(MM/DD/YYYY)

2. Total Redetermined
U.S. Tax Liability

3. Total U.S. Tax Liability
per Original/Amended Return

4. Difference
(subtract column 3 from column 2)

A
B
Schedule C (Form 1116) (12-2021)