1040-SR U.S. Tax Return for Seniors

Form

Version A, Cycle 4

1040-SR U.S. Tax Return for Seniors

2022

Department of the Treasury—Internal Revenue Service

Filing
Status

Check only
one box.

OMB No. 1545-0074

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

Single
Married filing jointly
Married filing separately (MFS)
Head of household (HOH)
Qualifying surviving spouse (QSS)
If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s
name if the qualifying person is a child but not your dependent:

Your first name and middle initial

Your social security number

Last name

INTERNAL USE ONLY
DRAFT AS OF
September 9, 2022

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

Spouse’s social security number

Last name

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

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

Apt. no.

Check here if you, or your
spouse if filing jointly, want $3
to go to this fund. Checking a
box below will not change
Foreign postal code your tax or refund.

State

ZIP code

Foreign province/state/county

Foreign country name

Presidential Election Campaign

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.) . . . . . .
You as a dependent
Your spouse as a dependent
Standard Someone can claim:
Spouse itemizes on a separate return or you were a dual-status alien
Deduction
You:
Were born before January 2, 1958
Are blind
Age/Blindness
Spouse:
Was born before January 2, 1958
Is blind

Digital
Assets

You

Spouse

Yes

No

{

Dependents

(see instructions): (1) First name

(2) Social security number (3) Relationship to (4) Check the box if qualifies for (see instructions):
you
Child tax credit
Credit for other dependents

Last name

If more than four
dependents, see
instructions and
check here

Income

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

1a

b Household employee wages not reported on Form(s) W-2 . . . . . .

1b

c Tip income not reported on line 1a (see instructions)

. . . . . . . .

1c

d Medicaid waiver payments not reported on Form(s) W-2 (see instructions)

1d

e Taxable dependent care benefits from Form 2441, line 26

1e

Attach
Form(s) W-2
here. Also
attach Forms
W-2G and
1099-R if tax
was
withheld.
If you did not
get a Form
W-2, see
instructions.

. . . . . .

f Employer-provided adoption benefits from Form 8839, line 29

. . . .

1f

. . . . . . . . . . . . . . . . .

1g

h Other earned income (see instructions) . . . . . . . . . . . . . .

1h

g Wages from Form 8919, line 6
i

Nontaxable combat pay election (see instructions)

.

1i

z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . .
Attach
Schedule B
if required.

2a Tax-exempt interest

1z

.

2a

b Taxable interest

. .

2b

3a Qualified dividends . .

3a

b Ordinary dividends .

3b

4a IRA distributions . . .

4a

b Taxable amount

. .

4b

5a Pensions and annuities

5a

b Taxable amount

. .

5b

6a Social security benefits .

6a

b Taxable amount

. .

6b

c If you elect to use the lump-sum election method, check here (see
instructions) . . . . . . . . . . . . . . . . . . . . . . . .
7

Capital gain or (loss). Attach Schedule D if required. If not required,
check here . . . . . . . . . . . . . . . . . . . . . . . .

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

Cat. No. 71930F

7
Form 1040-SR (2022)

Version A, Cycle 4
Page 2

Form 1040-SR (2022)

8

Other income from Schedule 1, line 10 . . . . . . . . . . . . . .

8

9

Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . .

9

10

Adjustments to income from Schedule 1, line 26 . . . . . . . . . .

10

11

Subtract line 10 from line 9. This is your adjusted gross income

. . .

11

Standard deduction or itemized deductions (from Schedule A)

. . .

12

13

Qualified business income deduction from Form 8995 or Form 8995-A .

13

14

Add lines 12 and 13

14

15

Subtract line 14 from line 11. If zero or less, enter -0-. This is your
taxable income . . . . . . . . . . . . . . . . . . . . . . .

Standard
Deduction 12

INTERNAL USE ONLY
DRAFT AS OF
September 9, 2022

See Standard
Deduction Chart
on the last page
of this form.

Tax and
Credits

16

. . . . . . . . . . . . . . . . . . . . .

Tax (see instructions). Check if any from:
1

. . . . . . .

16

17

Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . .

17

18

Add lines 16 and 17

18

19

Child tax credit or credit for other dependents from Schedule 8812

. .

19

20

Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . .

20

21

Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . .

21

22

Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . .

22

23

Other taxes, including self-employment tax, from Schedule 2, line 21 . .

23

24

Add lines 22 and 23. This is your total tax

24

Payments 25

Form(s) 8814

2

Form(s) 4972

3

. . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . .

Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . .

25a

b Form(s) 1099

. . . . . . . . . . . . . . . .

25b

c Other forms (see instructions) . . . . . . . . . .

25c

d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . .
If you have
a qualifying
child, attach
Sch. EIC.

15

25d

26

2022 estimated tax payments and amount applied from 2021 return . .

27

Earned income credit (EIC) . . . . . . . . . . .

27

28

Additional child tax credit from Schedule 8812 . . .

28

29

American opportunity credit from Form 8863, line 8 .

29

30

Reserved for future use . . . . . . . . . . . .

30

31

Amount from Schedule 3, line 15

31

32

Add lines 27, 28, 29, and 31. These are your total other payments and
refundable credits . . . . . . . . . . . . . . . . . . . . . .

32

Add lines 25d, 26, and 32. These are your total payments . . . . . .

33

33

. . . . . . . .

Go to www.irs.gov/Form1040SR for instructions and the latest information.

26

Form 1040-SR (2022)

Version A, Cycle 4
Page 3

Form 1040-SR (2022)

Refund 34

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

34

35a Amount of line 34 you want refunded to you. If Form 8888 is attached,
35a
check here . . . . . . . . . . . . . . . . . . . . . . . .
b Routing number

Direct deposit?
See
instructions.

c Type:

Checking

Savings

INTERNAL USE ONLY
DRAFT AS OF
September 9, 2022
d Account number

36

Amount 37
You Owe

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

36

38

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

Estimated tax penalty (see instructions) . . . . . .

37

38

Third Party
Designee

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

Sign
Here

Personal identification
Designee’s
Phone
number (PIN)
name
no.
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.
If the IRS sent you an Identity
Your signature
Date
Your occupation

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

Paid
Preparer
Use Only

Yes. Complete below.

No

Protection PIN, enter it here
(see inst.)

Spouse’s signature. If a joint return, both must sign.

Date

Phone no.

Email address

Preparer’s name

Preparer’s signature

Spouse’s occupation

Date

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

Check if:

PTIN

Self-employed
Firm’s name

Phone no.

Firm’s address

Firm’s EIN

Go to www.irs.gov/Form1040SR for instructions and the latest information.

Form 1040-SR (2022)

Version A, Cycle 4
Page 4

Form 1040-SR (2022)

Standard Deduction Chart*
Add the number of boxes checked in the “Age/Blindness” section of Standard Deduction on page 1 . . . . .

IF your filing
status is. . .

AND the number of
boxes checked is. . .

THEN your standard
deduction is. . .

1

$14,700

2

16,450

1

$27,300

2

28,700

3

30,100

4

31,500

Qualifying
surviving spouse

1

$27,300

2

28,700

Head of
household

1

$21,150

2

22,900

1

$14,350

2

15,750

3

17,150

4

18,550

INTERNAL USE ONLY
DRAFT AS OF
September 9, 2022

Single

Married
filing jointly

Married filing
separately**

* Don’t use this chart if someone can claim you (or your spouse if filing jointly) as a dependent, your spouse itemizes on a
separate return, or you were a dual-status alien. Instead, see instructions.
** You can check the boxes for your spouse if your filing status is married filing separately and your spouse had no
income, isn’t filing a return, and can’t be claimed as a dependent on another person’s return.
Go to www.irs.gov/Form1040SR for instructions and the latest information.

Form 1040-SR (2022)