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

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Form

1040-SS

U.S. Self-Employment Tax Return

OMB No. 1545-0074

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

2023

Please type or print.

U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, or Puerto Rico
Department of the Treasury
For the year Jan. 1–Dec. 31, 2023, or other tax year beginning
, 2023, 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

TREASURY/IRS
AND OMB USE
ONLY DRAFT
July 7, 2023
DO NOT FILE

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 2023, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, exchange, or
Yes
No
otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions) . . . . . . . .

Part I
1

2

Total Tax and Credits

Filing status. Check the box for your filing status. See instructions.
Single
Married filing jointly
Married filing separately (MFS)
Head of household
Qualifying surviving spouse
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 additional child tax
credit. See instructions. If more than four qualifying children, see instructions and check here . . . . . . . . . .
(a) First name
Last name
(b) Child’s social security number
(c) Child’s relationship to you

3

Self-employment tax from Schedule SE (Form 1040), line 12. Attach applicable schedules (see
instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
Household employment taxes (see instructions). Attach Schedule H (Form 1040) . . . . . . .
5
Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . . . .
6
Total tax. Add lines 3 through 5. See instructions . . . . . . . . . . . . . . . . .
7
2023 estimated tax payments (see instructions) . . . . . . . . . .
7
8
Excess social security tax withheld (see instructions) . . . . . . . .
8
9
Additional child tax credit from Part II, line 19 . . . . . . . . . . .
9
10
Reserved for future use . . . . . . . . . . . . . . . . . .
10
11a Credit for qualified sick and family leave wages from Schedule(s) H paid in
2023 for leave taken before April 1, 2021 . . . . . . . . . . . .
11a
b Credit for qualified sick and family leave wages from Schedule(s) H paid in
2023 for leave taken after March 31, 2021, and before October 1, 2021 . .
11b
12
Total payments and credits (see instructions) . . . . . . . . . . . . . . . . . .
13
If line 12 is more than line 6, subtract line 6 from line 12. This is the amount you overpaid . . . .
14a Amount of line 13 you want refunded to you. If Form 8888 is attached, check here . . . . .
c Type:
Checking
Savings
b Routing number
d Account number
15
Amount of line 13 you want applied to 2024 estimated tax . . . . . .
15
16
Amount you owe. If line 6 is more than line 12, subtract line 12 from line 6. See instructions . . .

Third Party
Designee

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

Paid
Preparer
Use Only

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

3
4
5
6

12
13
14a

16

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.
Your signature
Date
If the IRS sent you an Identity Protection PIN,
Daytime phone number
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
self-employed
Firm’s name

Firm’s EIN

Firm’s address

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

Phone no.
www.irs.gov/Form1040SS

Cat. No. 17184B

Form 1040-SS (2023)

Page 2

Form 1040-SS (2023)

Part II
1

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

Do you have one or more qualifying children under age 17 with the required social security number?
No. Stop. You can’t claim the credit.
Yes. Go to line 2.
Number of qualifying children under age 17 with the required social security number:
x $1,600. Enter the result . . . . . . . . . . . . . . . . . . .
Enter your modified adjusted gross income . . . . . . . . . . . .
3
Enter the amount shown below for your filing status . . . . . . . . .
4
• Married filing jointly – $400,000
• All other filing statuses – $200,000
Is the amount on line 3 more than the amount on line 4?
No. Leave line 5 blank. Enter the amount from line 2 on line 11, and go to
line 12.

2
3
4

5

2

TREASURY/IRS
AND OMB USE
ONLY DRAFT
July 7, 2023
DO NOT FILE

Yes. Subtract line 4 from line 3. If the result isn’t a multiple of $1,000,
increase it to the next multiple of $1,000 (for example, increase $425 to
$1,000, increase $1,025 to $2,000, etc.)
. . . . . . . . . . .
5
6
Multiply the amount on line 5 by 5% (0.05). Enter the result . . . . . . . . .
7
Number of qualifying children from line 2 x $2,000. Enter the result . . . .
7
8
Number of other dependents, including children who are not under age 17:
x $500. Enter the result. See instructions . . . . . .
8
9
Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . .
9
10
Is the amount on line 9 more than the amount on line 6?
No. Stop. You can’t claim the credit.
Yes. Subtract line 6 from line 9. Enter the result . . . . . . . . . . . .
11
Enter the smaller of line 2 or line 10 . . . . . . . . . . . . . . . . .
12a Enter one-half of self-employment tax from Part I, line 3 . . . . . . .
12a
b Enter one-half of the Additional Medicare Tax you paid on self-employment
income (Form 8959, line 13) . . . . . . . . . . . . . . . . .
12b
c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . .
12c

.

.

.

.

.

6

.
.

.
.

.
.

.
.

.
.

10
11

d Enter the amount, if any, of uncollected employee social security tax and
Medicare tax on tips and group-term life insurance (see instructions for Part I,
line 6) shown on the dotted line next to Part I, line 6 . . . . . . . . .
13d
e Enter the amount, if any, of Additional Medicare Tax on Medicare wages (Form
13e
8959, line 7) . . . . . . . . . . . . . . . . . . . . . .
f Add lines 13a through 13e . . . . . . . . . . . . . . . . .
13f
14
Add lines 12c and 13f. Enter the result . . . . . . . . . . . . .
14
15
Enter the amount, if any, of Additional Medicare Tax withheld (Form 8959, line
22) . . . . . . . . . . . . . . . . . . . . . . . . .
15
16
Subtract line 15 from line 14. Enter the result . . . . . . . . . . .
16
17
Enter the amount, if any, from Part I, line 8 . . . . . . . . . . . .
17
18
Is the amount on line 16 more than the amount on line 17?
No. Stop. You can’t claim the credit.
Yes. Subtract line 17 from line 16. Enter the result . . . . . . . . . . . .
19
Additional child tax credit. Enter the smaller of line 11 or line 18 here and on Part I, line 9

.
.

.
.

.
.

.
.

18
19

13a

Enter the amount, if any, of withheld social security, Medicare, and Additional
Medicare taxes from Puerto Rico Form(s) 499R-2/W-2PR (attach copy of
form(s)). If married filing jointly, include your spouse’s amounts with yours .
b Enter the amount, if any, of employee social security and Medicare tax on tips
not reported to employer from Form 4137 and shown on the dotted line next
to Part I, line 6 . . . . . . . . . . . . . . . . . . . . .
c

Enter the amount, if any, of uncollected employee social security and
Medicare tax on wages from Form 8919 shown on the dotted line next to
Part I, line 6 . . . . . . . . . . . . . . . . . . . . . .

13a

13b

13c

Form 1040-SS (2023)