Federal Free Printable 2016 Form 8843 for 2017 Federal Statement for Exempt Individuals and Individuals With a Medical Condition

It appears you don't have a PDF plugin for this browser. Please use the link below to download 2016-federal-form-8843.pdf, and you can print it directly from your computer.

Statement for Exempt Individuals and Individuals With a Medical Condition
2016 Form 8843

Form 8843 Statement for Exempt Individuals and Individuals With a Medical Condition OMB No. 1545-0074 2016 For use by alien individuals only. ▶ Department of the Treasury Internal Revenue Service Information about Form 8843 and its instructions is at www.irs.gov/form8843. beginning For the year January 1—December 31, 2016, or other tax year , 2016, and ending Your first name and initial Fill in your addresses only if you are filing this form by itself and not with your tax return Part I Last name Address in country of residence , 20 Attachment Sequence No. 102 . Your U.S. taxpayer identification number, if any Address in the United States General Information 1a Type of U.S. visa (for example, F, J, M, Q, etc.) and date you entered the United States b Current nonimmigrant status and date of change (see instructions) ▶ ▶ Of what country were you a citizen during the tax year? What country issued you a passport? Enter your passport number ▶ Enter the actual number of days you were present in the United States during: 2016 2015 2014 b Enter the number of days in 2016 you claim you can exclude for purposes of the substantial presence test 2 3a b 4a Part II ▶ Teachers and Trainees 5 For teachers, enter the name, address, and telephone number of the academic institution where you taught in 2016 ▶ 6 For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program you participated in during 2016 ▶ 7 Enter the type of U.S. visa (J or Q) you held during: ▶ 2010 2011 . If the type of visa you held during any 2012 2013 2014 2015 of these years changed, attach a statement showing the new visa type and the date it was acquired. Were you present in the United States as a teacher, trainee, or student for any part of 2 of the 6 prior calendar years (2010 through 2015)? . . . . . . . . . . . . . . . . . . . . . . . . Yes If you checked the “Yes” box on line 8, you cannot exclude days of presence as a teacher or trainee unless you meet the Exception explained in the instructions. 8 Part III 9 No Students Enter the name, address, and telephone number of the academic institution you attended during 2016 ▶ 10 Enter the name, address, and telephone number of the director of the academic or other specialized program you participated in during 2016 ▶ 11 Enter the type of U.S. visa (F, J, M, or Q) you held during: ▶ 2010 2011 . If the type of visa you held during any 2012 2013 2014 2015 of these years changed, attach a statement showing the new visa type and the date it was acquired. Were you present in the United States as a teacher, trainee, or student for any part of more than 5 calendar years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes If you checked the “Yes” box on line 12, you must provide sufficient facts on an attached statement to establish that you do not intend to reside permanently in the United States. 12 13 14 During 2016, did you apply for, or take other affirmative steps to apply for, lawful permanent resident status in the United States or have an application pending to change your status to that of a lawful permanent resident of the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . If you checked the “Yes” box on line 13, explain ▶ For Paperwork Reduction Act Notice, see page 4. Cat. No. 17227H Yes No No Form 8843 (2016) Page 2 Form 8843 (2016) Part IV Professional Athletes 15 Enter the name of the charitable sports event(s) in the United States in which you competed during 2016 and the dates of competition ▶ 16 Enter the name(s) and employer identification number(s) of the charitable organization(s) that benefited from the sports event(s) ▶ Note: You must attach a statement to verify that all of the net proceeds of the sports event(s) were contributed to the charitable organization(s) listed on line 16. Part V 17a Individuals With a Medical Condition or Medical Problem Describe the medical condition or medical problem that prevented you from leaving the United States ▶ b Enter the date you intended to leave the United States prior to the onset of the medical condition or medical problem described on line 17a ▶ c 18 Enter the date you actually left the United States ▶ Physician’s Statement: I certify that Name of taxpayer was unable to leave the United States on the date shown on line 17b because of the medical condition or medical problem described on line 17a and there was no indication that his or her condition or problem was preexisting. Name of physician or other medical official Physician’s or other medical official’s address and telephone number Date Physician’s or other medical official’s signature Under penalties of perjury, I declare that I have examined this form and the accompanying attachments, and, to the best of my knowledge and belief, they are true, correct, and complete. Your signature ▲ ▲ Sign here only if you are filing this form by itself and not with your tax return Date Form 8843 (2016) Page 3 Form 8843 (2016) General Instructions Section references are to the Internal Revenue Code unless otherwise specified. Future Developments For the latest information about developments related to Form 8843 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/form8843. Who Must File If you are an alien individual (other than a foreign government-related individual), you must file Form 8843 to explain the basis of your claim that you can exclude days of presence in the United States for purposes of the substantial presence test because you: • Were an exempt individual, or • Were unable to leave the United States because of a medical condition or medical problem. When and Where To File If you are filing a 2016 Form 1040NR or Form 1040NR-EZ, attach Form 8843 to it. Mail your tax return by the due date (including extensions) to the address shown in your tax return instructions. If you don’t have to file a 2016 tax return, mail Form 8843 to the Department of the Treasury, Internal Revenue Service Center, Austin, TX 73301-0215 by the due date (including extensions) for filing Form 1040NR or Form 1040NR-EZ. Penalty for Not Filing Form 8843 If you don’t file Form 8843 on time, you may not exclude the days you were present in the United States as a professional athlete or because of a medical condition or medical problem that arose while you were in the United States. Failure to exclude days of presence in the United States could result in your being considered a U.S. resident under the substantial presence test. You won’t be penalized if you can show by clear and convincing evidence that you took reasonable actions to become aware of the filing requirements and significant steps to comply with those requirements. Substantial Presence Test You are considered a U.S. resident if you meet the substantial presence test for 2016. You meet this test if you were physically present in the United States for at least: • 31 days during 2016, and • 183 days during the period 2016, 2015, and 2014, counting all the days of physical presence in 2016 but only 1/3 the number of days of presence in 2015 and only 1/6 the number of days in 2014. Note: To claim the closer connection to a foreign country(ies) exception to the substantial presence test described in Regulations section 301.7701(b)-2, you must file Form 8840, Closer Connection Exception Statement for Aliens. Days of presence in the United States. Generally, you are treated as being present in the United States on any day that you are physically present in the country at any time during the day. However, you don’t count the following days of presence in the United States for purposes of the substantial presence test. 1. Days you regularly commuted to work in the United States from a residence in Canada or Mexico. 2. Days you were in the United States for less than 24 hours when you were traveling between two places outside the United States. 3. Days you were temporarily in the United States as a regular crew member of a foreign vessel engaged in transportation between the United States and a foreign country or a possession of the United States unless you otherwise engaged in trade or business on such a day. 4. Days you were unable to leave the United States because of a medical condition or medical problem that arose while you were in the United States. 5. Days you were an exempt individual. Exempt Individuals For purposes of the substantial presence test, an exempt individual includes anyone in the following categories. • A teacher or trainee (defined on this page). • A student (defined on the next page). • A professional athlete temporarily present in the United States to compete in a charitable sports event. The term exempt individual also includes an individual temporarily present in the United States as a foreign government-related individual under an “A” or “G” visa, other than individuals holding “A-3” or “G-5” class visas. An individual present under an “A-3” or “G-5” class visa is not considered a foreign government-related individual and must count all his or her days of presence in the United States for purposes of the substantial presence test. For more details, see Pub. 519. If you are present under any other “A” or “G” class visa, you are not required to file Form 8843. Specific Instructions Part I—General Information If you are attaching Form 8843 to Form 1040NR or Form 1040NR-EZ, you aren’t required to complete lines 1a through 4a of Form 8843 if you provide the requested information on the corresponding lines of Form 1040NR or 1040NR-EZ. In this case, enter “Information provided on Form 1040NR” or “Information provided on Form 1040NR-EZ” on line 1a of Form 8843. Line 1b. Enter your current nonimmigrant status, such as that shown on your current Immigration Form I-94, Arrival-Departure Record. If your status has changed while in the United States, enter the date of change. Part II—Teachers and Trainees A teacher or trainee is an individual who is temporarily present in the United States under a “J” or “Q” visa (other than as a student) and who substantially complies with the requirements of the visa. If you were a teacher or trainee under a “J” or “Q” visa, you are considered to have substantially complied with the visa requirements if you haven’t engaged in activities that are prohibited by U.S. immigration laws that could result in the loss of your “J” or “Q” visa status. Even if you meet these requirements, you can’t exclude days of presence in 2016 as a teacher or trainee if you were exempt as a teacher, trainee, or student for any part of 2 of the 6 prior calendar years. But see the Exception below. If you qualify to exclude days of presence as a teacher or trainee, complete Parts I and II of Form 8843. If you have a “Q” visa, complete Part I and only lines 6 through 8 of Part II. On line 6, enter the name, address, and telephone number of the director of the cultural exchange program in which you participated. Exception. If you were exempt as a teacher, trainee, or student for any part of 2 of the 6 prior calendar years, you can exclude days of presence in 2016 as a teacher or trainee only if all four of the following apply. 1. You were exempt as a teacher, trainee, or student for any part of 3 (or fewer) of the 6 prior calendar years. 2. A foreign employer paid all your compensation during 2016. 3. You were present in the United States as a teacher or trainee in any of the 6 prior years. 4. A foreign employer paid all of your compensation during each of those prior 6 years you were present in the United States as a teacher or trainee. For more details, see Pub. 519, U.S. Tax Guide for Aliens. Page 4 Form 8843 (2016) If you meet this exception, you must attach information to verify that a foreign employer paid all the compensation you received in 2016 and all prior years that you were present in the United States as a teacher or trainee. Part III—Students A student is an individual who is temporarily present in the United States under an “F,” “J,” “M,” or “Q” visa and who substantially complies with the requirements of the visa. If you were a student under an “F,” “J,” “M,” or “Q” visa, you are considered to have substantially complied with the visa requirements if you haven’t engaged in activities that are prohibited by U.S. immigration laws and could result in the loss of your visa status. Even if you meet these requirements, you can’t exclude days of presence in 2016 as a student if you were exempt as a teacher, trainee, or student for any part of more than 5 calendar years unless you establish that you don’t intend to reside permanently in the United States. The facts and circumstances to be considered in determining if you have established that you don’t intend to reside permanently in the United States include, but aren’t limited to: 1. Whether you have maintained a closer connection to a foreign country than to the United States (for details, see Pub. 519), and 2. Whether you have taken affirmative steps to change your status from nonimmigrant to lawful permanent resident. If you qualify to exclude days of presence as a student, complete Parts I and III of Form 8843. If you have a “Q” visa, complete Part I and only lines 10 through 14 of Part III. On line 10, enter the name, address, and telephone number of the director of the cultural exchange program in which you participated. Part IV—Professional Athletes A professional athlete is an individual who is temporarily present in the United States to compete in a charitable sports event. For details on charitable sports events, see Pub. 519. If you qualify to exclude days of presence as a professional athlete, complete Parts I and IV of Form 8843. Part V—Individuals With a Medical Condition or Medical Problem For purposes of the substantial presence test, don’t count the days you intended to leave the United States but couldn’t do so because of a medical condition or medical problem that arose while you were in the United States. Whether you intended to leave the United States on a particular day is determined based on all the facts and circumstances. For more details, see Pub. 519. If you qualify to exclude days of presence because of a medical condition or medical problem, complete Part I and lines 17a through 17c of Part V. Have your physician or other medical official complete line 18. Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Section 7701(b) and its regulations require that you give us the information. We need it to determine if you can exclude days of presence in the United States for purposes of the substantial presence test. You aren’t required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. The average time and expenses required to complete and file this form will vary depending on individual circumstances. For the estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.
Extracted from PDF file 2016-federal-form-8843.pdf, last modified November 2016

More about the Federal Form 8843 Individual Income Tax TY 2016

We last updated the Statement for Exempt Individuals and Individuals With a Medical Condition in May 2017, so this is the latest version of Form 8843, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 8843 directly from TaxFormFinder. You can print other Federal tax forms here.

Other Federal Individual Income Tax Forms:

TaxFormFinder has an additional 774 Federal income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 1040-V Payment Voucher
1040 (Schedule A) Itemized Deductions
Form 1040 U.S. Individual Income Tax Return
1040 (Schedule B) Interest and Ordinary Dividends
1040 (Schedule SE) Self-Employment Tax

Download all  tax forms View all 775 Federal Income Tax Forms


Form Sources:

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 8843 from the Internal Revenue Service in May 2017.

Show Sources >

About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Federal Form 8843

We have a total of six past-year versions of Form 8843 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 8843

2016 Form 8843

Statement for Exempt Individuals and Individuals With a Medical Condition 2015 Form 8843

2015 Form 8843

Statement for Exempt Individuals and Individuals With a Medical Condition 2014 Form 8843

2014 Form 8843

Statement for Exempt Individuals and Individuals With a Medical Condition 2013 Form 8843

2013 Form 8843

Statement for Exempt Individuals and Individuals With a Medical Condition 2012 Form 8843

2012 Form 8843

Statement for Exempt Individuals and Individuals With a Medical Condition 2011 Form 8843

2011 Form 8843


TaxFormFinder Disclaimer:

While we do our best to keep our list of Federal Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

** This Document Provided By TaxFormFinder.org **
Source: http://www.taxformfinder.org/federal/form-8843