Form 8843

Department of the Treasury

Internal Revenue Service

Statement for Exempt Individuals and Individuals

With a Medical Condition

For the year January 1—December 31, 1993, or other tax year

beginning , 1993, and ending , 19 .

OMB No. 1545-1411

Your first name and initial

Address in country of residence

Your U.S. taxpayer identification number, if any

General Information

1a

2

3a

13

5

6

Enter the type of U.S. visa (e.g., F, J, M, etc.) and visa number, if any, you held during 1993 and the date it was acquired ©

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

What country issued you a passport?

Enter your passport number ©

During 1993, 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?

7

8

9

10

11

12

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

in during 1993 ©

Enter the type of U.S. visa (e.g., F, J, M, etc.), if any, you held during: ©

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

calendar years (1987 through 1992)?

If you answered “Yes” to line 8, you cannot exclude days of presence as a teacher or trainee unless you meet the exception

explained on page 3.

Enter the name, address, and telephone number of the academic institution you attended during 1993 ©

Yes No

Cat. No. 17227H Form 8843 (1993)

Part III

Part I

Part II Teachers and Trainees

Yes No

Students

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

in during 1993 ©

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

years?

If you answered “Yes” to 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.

Enter the name, address, and telephone number of the academic institution you attended during 1993 ©

Yes No

14 If you answered “Yes” to line 13, explain ©

(Under Section 7701(b) of the Internal Revenue Code)

Attachment

Sequence No. 102

1989 1990 1991 1992

1987 1988

For Paperwork Reduction Act Notice, see page 3.

Last name

Address in the United States Fill in your

addresses only if

you are filing this

form by itself and

not with your tax

return

b If the type of visa you held during 1993 changed, enter the new visa type and the date it was acquired ©

b

4a

b

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

Enter the number of days in 1993 you claim you can exclude for purposes of the substantial presence test ©

1993

1992 1991 .

. 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.

Enter the type of U.S. visa (e.g., F, J, M, etc.), if any, you held during: ©

1989 1990 1991 1992

1987 1988

. 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.
Form 8843 (1993) Page 2

Individuals With a Medical Condition or Medical Problem

b

c

18

Describe the medical condition or medical problem that prevented you from leaving the United States ©

Enter the date you intended to leave the United States prior to the onset of the medical condition or medical problem described

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 or other medical official’s address and telephone number

Professional Athletes

15

16

Enter the name of the charitable sports event(s) in the United States in which you competed during 1993 and the dates of

competition ©

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

Part IV

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. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any

knowledge.

© Your signature © Date

17a

Physician or other medical official’s signature Date

on line 17a ©
Form 8843 (1993) Page 3

General Instructions

Paperwork Reduction Act Notice

We ask for the information on this form to carry out the Internal Revenue laws of the

United States. You are required to give us the information. We need it to ensure that

you are complying with these laws and to allow us to figure and collect the right

amount of tax.

The time needed to complete and file this form will vary depending on individual

circumstances. The estimated average time is:

Recordkeeping 13 min.

Learning about the law

or the form 5 min.

Preparing the form 29 min.

Copying, assembling, and

sending the form to the IRS 17 min.

If you have comments concerning the accuracy of these time estimates or

suggestions for making this form more simple, we would be happy to hear from you.

You can write to both the Internal Revenue Service, Attention: Reports Clearance

Officer, PC:FP, Washington, DC 20224; and the Office of Management and Budget,

Paperwork Reduction Project (1545-1411), Washington, DC 20503. DO NOT send

this form to either of these offices. Instead, see How To File on page 4.

Section references are to the Internal

Revenue Code unless otherwise noted.

Who Must File

You, as an alien individual, must file

Form 8843 or a similar statement 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 (other than

a foreign government-related individual),

or

Substantial Presence Test

You are considered a U.S. resident if you

meet the substantial presence test for

1993. You meet this test if you were

physically present in the United States

for at least:

● 31 days during 1993, and

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 do not count the

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 in

transit between two places outside the

United States.

3. Days you were unable to leave the

United States because of a medical

condition or medical problem that

developed while you were in the United

States.

4. 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, temporarily

present in the United States under a “J”

visa (other than as a student), who

substantially complies with the

requirements of the visa.

● A student, temporarily present in the

United States under an “F,” “J,” or “M”

visa, who substantially complies with the

requirements of the visa.

● A professional athlete temporarily in

the United States to compete in a

charitable sports event.

Teachers and Trainees (Part II)

If you were a teacher or trainee under a

“J” visa, you are considered to have

substantially complied with the visa

requirements if you have not engaged in

activities that are prohibited by U.S.

Even if you meet these requirements,

you cannot exclude days of presence in

1993 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.

Students (Part III)

If you were a student under an “F,” “J,”

or “M” visa, you are considered to have

substantially complied with the visa

requirements if you have not engaged in

activities that are prohibited by U.S.

immigration laws and could result in the

loss of your visa status. 

● Were unable to leave the United

States because of a medical condition

or medical problem.

● 183 days during the period 1993,

1992, and 1991, counting all the days of

physical presence in 1993 but only 1/3

the number of days of presence in 1992

and only 1/6 the number of days in

1991.

Form 8843

Parts I & II

Form 8843

Parts I & III

Form 8843

Parts I & IV

Form 8843

Parts I & V

13 min. 13 min. 13 min.

5 min. 4 min. 5 min.

34 min. 24 min. 34 min.

17 min. 17 min. 17 min.

2. A foreign employer paid all your

compensation during 1993.

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.

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.

Note: To claim the closer connection to

a foreign country or countries exception

to the substantial presence test

described in Regulations section

301.7701(b)-2, you must file Form 8840,

Closer Connection Exception Statement,

or a similar statement.

● An individual temporarily present in

the United States as a foreign

government-related individual.

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 1993

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.

If you meet this exception, you must

attach information to verify that a foreign

employer paid all the compensation you

received in 1993 and all prior years that

you were present in the United States as

a teacher or trainee.

Even if you meet these requirements,

you cannot exclude days of presence in

1993 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 to the satisfaction

of the IRS district director that you do

not intend to reside permanently in the

United States. The facts and

circumstances to be considered in

determining if you have demonstrated

an intent to reside permanently in the

United States include, but are not limited

to:

following days of presence in the United

States for purposes of the substantial

presence test:

immigration laws and could result in the

loss of your “J” visa status.
Penalty for Not Filing Form

8843 or a Similar Statement

If you do not timely file Form 8843 or a

similar statement, 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.

Form 8843 (1993) Page 4

You will not 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.

Professional Athletes (Part IV)

A professional athlete is an individual

who is temporarily 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.

How To File

Attach Form 8843 to your 1993 income

tax return. If you do not have to file a

return, send the form to the Internal

Revenue Service Center, Philadelphia,

PA 19255 by the due date (including

extensions) for filing Form 1040NR. See

the Instructions for Form 1040NR.

If you qualify to exclude days of

presence as a student, complete Parts I

and III of Form 8843.

Individuals With a Medical

Condition or Medical

Problem (Part V)

For purposes of the substantial presence

test, do not count the days you intended

to leave the United States but could not

do so because of a medical condition or

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 of Part V.

medical problem that developed 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.