1040-NR U.S. Nonresident Alien Income Tax Return

Form

Version A, Cycle 9

1040-NR U.S. Nonresident Alien Income Tax Return 2022
Department of the Treasury—Internal Revenue Service

For the year Jan. 1–Dec. 31, 2022, or other tax year beginning

Filing
Status

Single

OMB No. 1545-0074

, 2022, ending

Married filing separately (MFS)

IRS Use Only—Do not write
or staple in this space.

See separate
instructions.

, 20

Qualifying surviving spouse (QSS)

Estate

Check only
one box.

Your first name and middle initial

Your identifying number
(see instructions)

Last name

Home address (number and street). If you have a P.O. box, see instructions.

Apt. no.

City, town, or post office. If you have a foreign address, also complete spaces below.

State

Foreign province/state/county

Foreign country name

Digital Assets

Trust

If you checked the QSS box, enter the child’s name if the qualifying person is a child but not your dependent:

ZIP code

Foreign postal code

At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, exchange, gift, or
otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) . . . . . .
Yes
No

Dependents
(see instructions):

(1) First name

(2) Dependent’s
identifying number

Last name

(4) Check the box if qualifies for (see inst.):
Credit for other
Child tax credit
dependents

(3) Relationship to you

If more than four
dependents, see
instructions and
check here

INTERNAL USE ONLY
DRAFT AS OF
September 27, 2022

Income
Effectively
Connected
With U.S.
Trade or
Business

1a

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1a

b
c
d

Household employee wages not reported on Form(s) W-2 . . . . . .
Tip income not reported on line 1a (see instructions) . . . . . . .
Medicaid waiver payments not reported on Form(s) W-2 (see instructions) .

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1b
1c
1d

e
f
g

Taxable dependent care benefits from Form 2441, line 26 . .
Employer-provided adoption benefits from Form 8839, line 29
Wages from Form 8919, line 6 . . . . . . . . . .

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1e
1f
1g

h
i
j

Other earned income (see instructions)
Reserved for future use . . . . .
Reserved for future use . . . . .

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1h

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1i
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1j

k

Total income exempt by a treaty from Schedule OI (Form 1040-NR), item L,
line 1(e)
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Add lines 1a through 1h . . . . . . . . . . . . . . . .

1k
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b Taxable interest . .
b Ordinary dividends .
b Taxable amount . .

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Total amount from Form(s) W-2, box 1 (see instructions)

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Attach
Form(s) W-2,
1042-S,
SSA-1042-S,
RRB-1042-S,
and 8288-A
here. Also
attach
Form(s)
1099-R if
tax was
withheld.

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1z

2a
3a
4a

Tax-exempt interest .
Qualified dividends .
IRA distributions . .

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2b
3b
4b

If you did not
get a Form
W-2, see
instructions.

5a
6
7

Pensions and annuities . .
5a
b Taxable amount . . . .
Reserved for future use . . . . . . . . . . . . . . . . . . . . .
Capital gain or (loss). Attach Schedule D (Form 1040) if required. If not required, check here .

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5b
6
7

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8
9

a

Other income from Schedule 1 (Form 1040), line 10 . . . . . . . . . . . .
Add lines 1z, 2b, 3b, 4b, 5b, 7, and 8. This is your total effectively connected income .
Adjustments to income:
10a
From Schedule 1 (Form 1040), line 26 . . . . . . . . . . .

b
c

Reserved for future use .
Reserved for future use .

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10d
11

z

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9
10

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2a
3a
4a

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10b
10c

d
11

Enter the amount from line 10a. These are your total adjustments to income .
Subtract line 10d from line 9. This is your adjusted gross income . . . .

12
13a
b

Itemized deductions (from Schedule A (Form 1040-NR)) or, for certain residents of India, standard
deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . .
Qualified business income deduction from Form 8995 or Form 8995-A .
13a
Exemptions for estates and trusts only (see instructions) . . . . .
13b

c
14
15

Add lines 13a and 13b . . . . . . . . . . . . . . . . . .
Add lines 12 and 13c
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Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income

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

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Cat. No. 11364D

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13c
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15
Form 1040-NR (2022)

Version A, Cycle 9
Page 2

Form 1040-NR (2022)

Tax and
Credits

16

Tax (see instructions). Check if any from Form(s):

17
18
19

Amount from Schedule 2 (Form 1040), line 3 . . . . . . . . . . .
Add lines 16 and 17 . . . . . . . . . . . . . . . . . .
Child tax credit or credit for other dependents from Schedule 8812 (Form 1040)

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17
18
19

20
21
22

Amount from Schedule 3 (Form 1040), line 8 . . .
Add lines 19 and 20 . . . . . . . . . .
Subtract line 21 from line 18. If zero or less, enter -0-

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20
21
22

23a

Tax on income not effectively connected with a U.S. trade or business from
Schedule NEC (Form 1040-NR), line 15 . . . . . . . . . .

1040),
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23b
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23c
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b
c
d

Payments

Other taxes, including self-employment
line 21 . . . . . . . . . .
Transportation tax (see instructions) .
Add lines 23a through 23c . . . .

tax,
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1

2

8814

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from Schedule 2 (Form
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3

4972

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23a

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23d

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24

a

Add lines 22 and 23d. This is your total tax .
Federal income tax withheld from:
Form(s) W-2 . . . . . . . . . .

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b
c
d

Form(s) 1099 . . . . . .
Other forms (see instructions) .
Add lines 25a through 25c . .

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25a
25b
25c
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25d

e
f
g

Form(s) 8805 .
Form(s) 8288-A
Form(s) 1042-S

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25e
25f
25g

26
27
28

2022 estimated tax payments and amount applied from 2021 return .
Reserved for future use . . . . . . . . . . . . . .
Additional child tax credit from Schedule 8812 (Form 1040) . . .

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27
28

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26

29
30
31
32
33

Credit for amount paid with Form 1040-C
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29
30
Reserved for future use . . . . . . . . . . . . . . .
Amount from Schedule 3 (Form 1040), line 15 . . . . . . . .
31
Add lines 28, 29, and 31. These are your total other payments and refundable credits .
Add lines 25d, 25e, 25f, 25g, 26, and 32. These are your total payments . . . . .

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34

If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid

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33
34

24
25

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INTERNAL USE ONLY
DRAFT AS OF
September 27, 2022

Refund

35a
Direct deposit?
b
See instructions.
d
e

Amount
You Owe
Third
Party
Designee

Sign
Here
Paid
Preparer
Use Only

Amount of line 34 you want refunded to you. If Form 8888 is attached, check here .
Routing number
c Type:
Checking
Account number

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Savings

35a

If you want your refund check mailed to an address outside the United States not shown on page 1,
enter it here.

36

Amount of line 34 you want applied to your 2023 estimated tax

37

Subtract line 33 from line 24. This is the amount you owe.
For details on how to pay, go to www.irs.gov/Payments or see instructions .

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38

Estimated tax penalty (see instructions)

38

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36
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Do you want to allow another person to discuss this return with the IRS? See instructions.
Designee’s
name

Phone
no.

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37

Yes. Complete below.

No

Personal identification
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 taxpayer) is based on all information of which preparer has any knowledge.

Your signature

Phone no.
Preparer’s name

Date

Email address
Preparer’s signature

Firm’s name
Firm’s address

Go to www.irs.gov/Form1040NR for instructions and the latest information.

If the IRS sent you an Identity
Protection PIN, enter it here
(see inst.)

Your occupation

Date

PTIN

Check if:
Self-employed

Phone no.
Firm’s EIN
Form 1040-NR (2022)