Federal Nonresident Alien Intake and Interview Sheet
Extracted from PDF file 2021-federal-form-13614-nr.pdf, last modified July 2021
Nonresident Alien Intake and Interview SheetDepartment of the Treasury - Internal Revenue Service Form 13614-NR (October 2021) Last or Family Name First ITIN or Social Security # Date of Birth: Middle Initial Visa # / (mm/dd/yyyy) OMB Number 1545-2075 Nonresident Alien Intake and Interview Sheet Passport # Telephone # / e-mail Address Were you a U.S. citizen or resident alien the entire year? Yes No Were you ever a U.S. citizen? Yes No Resident of India Yes No U.S. Local Street Address City State Zip Code Foreign Residence Address Address Line 2 Foreign Country Province/County Country of Citizenship Are you married? Postal Code Country that issued Passport Yes No If “YES”, is your spouse in the U.S.? If "YES", is it recognized by the State where you will be filing? Are you a U.S. National Yes No Resident of Canada Yes No Resident of Mexico Yes No Yes No Yes No Resident of South Korea Yes No Dependent Information First Name Last or Family Name Date of Birth (mm/dd/yyyy) Relationship to you (son, daughter, none, etc.) ITIN or SSN / What is the date you FIRST entered the United States? U.S. citizen, Number of U.S. resident months alien, lived with U.S. national, Did you in the or a resident of person file U.S. in Canada, Mexico, joint 2021 or South Korea return? Did the Did person Did you person provide provide have more than more than Gross 50% of 50% of Income of their own their $4,300 or support? support? more? / Were you prevented from exiting the U.S. due to COVID-19, Emergency Travel Disruptions on or after 2-1-2020 and before 4-2-2020? (This may affect the substantial presence test) Yes No Entry Immigration Status - Check one U.S. Immigrant/Permanent Resident F-1 Student F-2 Spouse or child of Student H-1 Temporary Employee *J-1 Exchange Visitor J-2 Spouse or child of Exchange Visitor U.S. Immigrant/Permanent Resident F-1 Student F-2 Spouse or child of Student H-1 Temporary Employee *J-1 Exchange Visitor J-2 Spouse or child of Exchange Visitor Other (list) Current Immigration Status - Check one Other (list) Have you ever changed your visa type or U.S. immigration status? If “Yes”, indicate the date and nature of the change. / Yes No / Enter the type of U.S. visa you held during these years 2015 2016 2017 2018 2019 2020 * If Immigration status is J-1, what is the subtype? Check one 01 Student 05 Professor 02 Short Term Scholar Other (list) 12 Research Scholar What is the actual primary activity of the visit? Check one 01 Studying in a Degree Program 04 Lecturing 07 Conducting Research 10 Clinical Activities 02 Studying in a Non-Degree Program 05 Observing 08 Training 11 Temporary Employment 03 Teaching 06 Consulting 09 Demonstrating Special Skills 12 Here with Spouse Catalog Number 39748B www.irs.gov Form 13614-NR (Rev. 10-2021) Check the years you were present in the United States as a teacher, trainee, student or as an accompanying spouse or dependent of a person in such status for any part of the year. 2015 2016 2017 2018 2019 2020 Have you ever been present in the U.S. PRIOR to 2015 on a teacher, trainee, student visa, or as their accompanying spouse or dependent? Yes No If so, what years and visa type How many days (including vacations, nonworkdays and partial days) were you present in the U.S. during 2019 2020 2021 List the dates you entered and left the United States during 2021 Date entered United States mm/dd/yyyy Date departed United States mm/dd/yyyy Date entered United States mm/dd/yyyy Did you file a U.S. income tax return for any year before 2021? / If “Yes”, give latest year / Yes Date departed United States mm/dd/yyyy No Form number filed During 2021, did you apply to be a green card holder (lawful permanent resident) of the United States? Do you have an application pending to change your status to lawful permanent resident? 1. Are you claiming the benefits of a U.S. income tax treaty with a foreign country? Yes Yes Yes No No No If “Yes”, enter the appropriate information in the columns below (a) Country (b) Tax Treaty Article (c) Number of months (d) Amount of exempt claimed in prior tax years income in current tax year 2. Were you subject to tax in a foreign country on any of the income shown in 1(d) above? Yes No Information about academic institution you attended in 2021 Name Telephone number Address Name of your academic/specialized program director Telephone number Address During 2021 did you receive Did you have Scholarships or Fellowship Grants Yes No Wages, Salaries or Tips Yes No Casualty Losses in a Declared Disaster Area Yes No Interest Yes No Student Loan Interest Paid Yes No Distributions from IRA, Pension or Annuity Yes No State or Local Income Taxes Yes No State or Local Tax Refunds Yes No U.S. Charitable Contributions Yes No Unemployment Compensation Yes No Child/Dependent Care Expenses Yes No Dividend income or capital gains or losses Yes No IRA Contributions Yes No Any Other Income (gambling, lottery, prizes, awards, self-employment, rents, royalties, virtual currency, etc.) Yes No Did you or any dependent have health insurance coverage through HealthCare.gov (The Marketplace)? Yes No If yes, was any Advanced Premium Tax Credit received? (Provide Form 1095-A) Yes No Privacy Act and Paperwork Reduction Act Notice The Privacy Act of 1974 requires that when we ask for information we tell you our legal right to ask for the information, why we are asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for information is 5 U.S.C. 301. We are asking for this information to assist us in contacting you relative to your interest and/or participation in the IRS volunteer income tax preparation and outreach programs. The information you provide may be furnished to others who coordinate activities and staffing at volunteer return preparation sites or outreach activities. The information may also be used to establish effective controls, send correspondence and recognize volunteers. Your response is voluntary. However, if you do not provide the requested information, the IRS may not be able to use your assistance in these programs. The Paperwork Reduction Act requires that the IRS display an OMB control number on all public information requests. The OMB Control Number for this study is 1545-2075. Also, if you have any comments regarding the time estimates associated with this study or suggestion on making this process simpler, please write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224. Catalog Number 39748B www.irs.gov Form 13614-NR (Rev. 10-2021)
Form 13614-NR (Rev. 10-2021)
More about the Federal Form 13614-NR Other Nonresident TY 2021
We last updated the Nonresident Alien Intake and Interview Sheet in January 2022, so this is the latest version of Form 13614-NR, fully updated for tax year 2021. You can download or print current or past-year PDFs of Form 13614-NR directly from TaxFormFinder. You can print other Federal tax forms here.
Other Federal Other Forms:
|Form Code||Form Name|
|Form W-4V||Voluntary Withholding Request|
|Form 8962||Premium Tax Credit|
|Form 8840||Closer Connection Exception Statement for Aliens|
|Form 14039||Identity Theft Affidavit|
|Form 8959||Additional Medicare Tax|
The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 13614-NR from the Internal Revenue Service in January 2022.
Form 13614-NR is a Federal Other form. Many states have separate versions of their tax returns for nonresidents or part-year residents - that is, people who earn taxable income in that state live in a different state, or who live in the state for only a portion of the year. These nonresident returns allow taxpayers to specify which which income is subject to the state's taxes, and which is not.
Historical Past-Year Versions of Federal Form 13614-NR
We have a total of nine past-year versions of Form 13614-NR in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
Form 13614-NR (Rev. 10-2021)
Form 13614-NR (Rev. 10-2020)
Form 13614-NR (Rev. 10-2019)
Form 13614-NR (Rev. 10-2018)
Form 13614-NR (Rev. 10-2017)
Form 13614-NR (Rev. 10-2016)
Form 13614-NR (Rev. 10-2015)
Form 13614NR (Rev. 10-2012)
Form 13614NR (Rev. 9-2011)
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