Form 8843

Department of the Treasury 

Internal Revenue Service

Statement for Exempt Individuals and Individuals 

With a Medical Condition

For use by alien individuals only.

▶ Go to www.irs.gov/Form8843 for the latest information.

For the year January 1—December 31, 2021, or other tax year

beginning , 2021, and ending , 20 .

OMB No. 1545-0074

2021

Attachment 

Sequence No. 102

Your first name and initial Last name Your U.S. taxpayer identification number, if any

Fill in your 

addresses only if 

you are filing this 

form by itself and 

not with your tax 

return

Address in country of residence Address in the United States

Part I 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. If your status has changed, also enter date of change and previous status. See instructions.

2 Of what country or countries were you a citizen during the tax year?

3a What country or countries issued you a passport?

b Enter your passport number(s) ▶

4a Enter the actual number of days you were present in the United States during:

2021 2020 2019

b Enter the number of days in 2021 you claim you can exclude for purposes of the substantial presence test ▶

Part II Teachers and Trainees

5 For teachers, enter the name, address, and telephone number of the academic institution where you taught in 2021 ▶

6 For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program

you participated in during 2021 ▶

7 Enter the type of U.S. visa (J or Q) you held during: ▶ 2015 2016

2017 2018 2019 2020 . If the type of visa you held during any

of these years changed, attach a statement showing the new visa type and the date it was acquired.

8 Were you present in the United States as a teacher, trainee, or student for any part of 2 of the 6 prior 

calendar years (2015 through 2020)? . . . . . . . . . . . . . . . . . . . . . . . . Yes No

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.

Part III Students

9 Enter the name, address, and telephone number of the academic institution you attended during 2021 ▶

10 Enter the name, address, and telephone number of the director of the academic or other specialized program you participated 

in during 2021 ▶

11 Enter the type of U.S. visa (F, J, M, or Q) you held during: ▶ 2015 2016

2017 2018 2019 2020 . If the type of visa you held during any

of these years changed, attach a statement showing the new visa type and the date it was acquired.

12 Were you present in the United States as a teacher, trainee, or student for any part of more than 5 calendar 

years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

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.

13 During 2021, 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? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

14 If you checked the “Yes” box on line 13, explain ▶

For Paperwork Reduction Act Notice, see instructions. Cat. No. 17227H Form 8843 (2021)
Form 8843 (2021) Page 2

Part IV Professional Athletes

15 Enter the name of the charitable sports event(s) in the United States in which you competed during 2021 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 Individuals With a Medical Condition or Medical Problem

17a Describe the medical condition or medical problem that prevented you from leaving the United States. 

See instructions. ▶

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 Enter the date you actually left the United States ▶

18 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

Physician’s or other medical official’s signature Date

Sign here 

only if you 

are filing 

this form by 

itself and 

not with 

your tax 

return

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 ▲Date

Form 8843 (2021)
Form 8843 (2021) Page 3

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.

What’s New

COVID-19 Medical Condition Travel 

Exception (Rev. Proc. 2020-20 

Exception). For tax year 2021, individuals 

cannot claim the COVID-19 medical 

condition travel exception to exclude any 

days of presence in the United States for 

the purpose of the “substantial presence 

test.” However, days of presence in the 

United States in 2020 that were excluded 

for tax year 2020 may impact the 

application of the “substantial presence 

test” for tax year 2021. For more 

information, see Days of presence in the 

United States, later.

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 2021 Form 1040-NR, 

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 2021 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 

1040-NR.

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 

2021. You meet this test if you were 

physically present in the United States for 

at least:

• 31 days during 2021; and

• 183 days during the period 2021, 2020, 

and 2019, counting all the days of physical 

presence in 2021 but only 1/3 the number 

of days of presence in 2020 and only 1/6 

the number of days in 2019. 

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.

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.

Note: For more information on determining 

resident alien or nonresident alien status 

under the “substantial presence test” as a 

result of having applied the COVID-19 

Medical Condition Travel Exception to 

exclude days of presence in the United 

States in 2020, see Rev. Proc. 2020-20, 

2020-20 I.R.B. 801, available at www.irs.

gov/irb/2020-20_IRB#REV-PROC-2020-20.

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 governmentrelated 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 

1040-NR, 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 1040-NR. See 

Schedule OI of those forms.

In this case, enter “Information provided 

on Form 1040-NR” on line 1a of Form 

8843. Complete line 4b and the rest of 

Form 8843.

If Form 8843 is filed separately, you must 

complete all entries on the form.

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 

and previous status.

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 2021 

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.
Form 8843 (2021) Page 4

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 2021 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 2021.

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.

If you meet this exception, you must 

attach information to verify that a foreign 

employer paid all the compensation you 

received in 2021 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 2021 

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.

Note: You cannot exclude any days of 

presence in the United States under any of 

the following circumstances.

• You were initially prevented from leaving, 

were then able to leave, but remained in 

the United States beyond a reasonable 

period for making arrangements to leave.

• You entered or returned to the United 

States for medical treatment. It does not 

matter whether you intended to leave the 

United States immediately after the 

medical treatment but couldn’t do so 

because of unforeseen complications from 

the medical treatment.

• The medical condition existed before 

your arrival in the United States and you 

were aware of the condition. It does not 

matter whether you needed treatment for 

the condition when you entered the United 

States.

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.