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Statement for Exempt Individuals and Individuals OMB No. 1545-0074
Form 8843 With a Medical Condition
For use by alien individuals only.
2022
Go to www.irs.gov/Form8843 for the latest information.
Attachment
Department of the Treasury For the year January 1—December 31, 2022, or other tax year Sequence No. 102
Internal Revenue Service beginning , 2022, and ending , 20 .
Your first name and initial Last name Your U.S. taxpayer identification number, if any

Fill in your Address in country of residence Address in the United States
addresses only if
you are filing this
form by itself and
not with your tax
return
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:
2022 2021 2020
b Enter the number of days in 2022 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 2022:

6 For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program you
participated in during 2022:

7 Enter the type of U.S. visa (J or Q) you held during: 2016 2017
2018 2019 2020 2021 . 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 (2016 through 2021)? . . . . . . . . . . . . . . . . . . . . . . . . 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 2022:

10 Enter the name, address, and telephone number of the director of the academic or other specialized program you participated
in during 2022:

11 Enter the type of U.S. visa (F, J, M, or Q) you held during: 2016 2017
2018 2019 2020 2021 . 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 2022, 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 (2022)

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Form 8843 (2022)                                                                                                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 2022 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        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, 
only if you      they are true, correct, and complete.
are filing  
this form by 
itself and  
not with  
your tax 
return                                                Your signature                                       Date
                                                                                                           Form 8843 (2022)

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Form 8843 (2022) Page 3
General Instructions Days of presence in the United States. Line 1b.Enter your current nonimmigrant
Generally, you are treated as being present status, such as that shown on your current
Section references are to the Internal in the United States on any day that you Immigration Form I-94, Arrival-Departure
Revenue Code unless otherwise specified. are physically present in the country at any Record. If your status has changed while in
Future Developments time during the day. However, you don’t the United States, enter the date of change
For the latest information about count the following days of presence in the and previous status.
developments related to Form 8843 and its United States for purposes of the
instructions, such as legislation enacted substantial presence test. Part II—Teachers and Trainees
after they were published, go to 1. Days you regularly commuted to work A teacher or trainee is an individual who is
www.irs.gov/Form8843. in the United States from a residence in temporarily present in the United States
Canada or Mexico. under a “J” or “Q” visa (other than as a
student) and who substantially complies
Who Must File 2. Days you were in the United States for with the requirements of the visa.
If you are an alien individual (other than a less than 24 hours when you were traveling
foreign government-related individual), you between two places outside the United If you were a teacher or trainee under a
must file Form 8843 to explain the basis of States. “J” or “Q” visa, you are considered to have
substantially complied with the visa
your claim that you can exclude days of 3. Days you were temporarily in the requirements if you haven’t engaged in
presence in the United States for purposes United States as a regular crew member of activities that are prohibited by U.S.
of the substantial presence test because a foreign vessel engaged in transportation immigration laws that could result in the
you: between the United States and a foreign loss of your “J” or “Q” visa status.
• Were an exempt individual, or country or a possession of the United
• Were unable to leave the United States States unless you otherwise engaged in Even if you meet these requirements,
because of a medical condition or medical trade or business on such a day. you can’t exclude days of presence in 2022
as a teacher or trainee if you were exempt
problem. 4. Days you were unable to leave the as a teacher, trainee, or student for any
When and Where To File United States because of a medical part of 2 of the 6 prior calendar years. But
condition or medical problem that arose see the Exception later.
If you are filing a 2022 Form 1040-NR, while you were in the United States.
If you qualify to exclude days of
attach Form 8843 to it. Mail your tax return 5. Days you were an exempt individual. presence as a teacher or trainee, complete
by the due date (including extensions) to
the address shown in your tax return Exempt Individuals Parts I and II of Form 8843. If you have a
“Q” visa, complete Part I and only lines 6
instructions. For purposes of the substantial presence through 8 of Part II. On line 6, enter the
If you don’t have to file a 2022 tax return, test, an exempt individual includes anyone name, address, and telephone number of
mail Form 8843 to the Department of the in the following categories. the director of the cultural exchange
Treasury, Internal Revenue Service Center, • A teacher or trainee (defined on this program in which you participated.
Austin, TX 73301-0215 by the due date page). Exception. If you were exempt as a
(including extensions) for filing Form
1040-NR. • A student (defined on the next page). teacher, trainee, or student for any part of 2
• A professional athlete temporarily present of the 6 prior calendar years, you can
Penalty for Not Filing Form 8843 in the United States to compete in a exclude days of presence in 2022 as a
If you don’t file Form 8843 on time, you charitable sports event. teacher or trainee only if all four of the
may not exclude the days you were following apply.
present in the United States as a The term “exempt individual” also 1. You were exempt as a teacher,
professional athlete or because of a includes an individual temporarily present trainee, or student for any part of 3 (or
medical condition or medical problem that in the United States as a foreign fewer) of the 6 prior calendar years.
arose while you were in the United States. government-related individual under an “A” 2. A foreign employer paid all your
Failure to exclude days of presence in the or “G” visa, other than individuals holding compensation during 2022.
United States could result in your being “A-3” or “G-5” class visas. An individual
considered a U.S. resident under the present under an “A-3” or “G-5” class visa 3. You were present in the United States
substantial presence test. is not considered a foreign government- as a teacher or trainee in any of the 6 prior
You won’t be penalized if you can show related individual and must count all his or years.
by clear and convincing evidence that you her days of presence in the United States 4. A foreign employer paid all of your
took reasonable actions to become aware for purposes of the substantial presence compensation during each of those prior 6
of the filing requirements and significant test. For more details, see Pub. 519. If you years you were present in the United
steps to comply with those requirements. are present under any other “A” or “G” States as a teacher or trainee.
class visa, you are not required to file Form For more details, see Pub. 519.
Substantial Presence Test 8843.
If you meet this exception, you must
You are considered a U.S. resident if you attach information to verify that a foreign
meet the substantial presence test for Specific Instructions
employer paid all the compensation you
2022. You meet this test if you were Part I—General Information received in 2022 and all prior years that
physically present in the United States for you were present in the United States as a
at least: If you are attaching Form 8843 to Form
1040-NR, you aren’t required to complete teacher or trainee.
• 31 days during 2022; and lines 1a through 4a of Form 8843 if you
• 183 days during the period 2022, 2021, provide the requested information on the
and 2020, counting all the days of physical corresponding lines of Form 1040-NR. See
presence in 2022 but only 1/3 the number Schedule OI of those forms.
of days of presence in 2021 and only 1/6 In this case, enter “Information provided
the number of days in 2020. on Form 1040-NR” on line 1a of Form
Note: To claim the closer connection to a 8843. Complete line 4b and the rest of
foreign country(ies) exception to the Form 8843.
substantial presence test described in If Form 8843 is filed separately, you must
Regulations section 301.7701(b)-2, you complete all entries on the form.
must file Form 8840.

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Form 8843 (2022) Page 4
Part III—Students Part IV—Professional Athletes • The medical condition existed before
A student is an individual who is A professional athlete is an individual who your arrival in the United States and you
temporarily present in the United States is temporarily present in the United States were aware of the condition. It does not
under an “F,” “J,” “M,” or “Q” visa and who to compete in a charitable sports event. matter whether you needed treatment for
substantially complies with the For details on charitable sports events, see the condition when you entered the United
requirements of the visa. Pub. 519. States.
If you were a student under an “F,” “J,” If you qualify to exclude days of • You were initially prevented from leaving,
“M,” or “Q” visa, you are considered to presence as a professional athlete, were then able to leave, but remained in
have substantially complied with the visa complete Parts I and IV of Form 8843. the United States beyond a reasonable
requirements if you haven’t engaged in period for making arrangements to leave.
activities that are prohibited by U.S. Part V—Individuals With a Medical
immigration laws and could result in the Condition or Medical Problem Paperwork Reduction Act Notice. We
loss of your visa status. For purposes of the substantial presence ask for the information on this form to carry
Even if you meet these requirements, test, don’t count the days you intended to out the Internal Revenue laws of the United
you can’t exclude days of presence in 2022 leave the United States but couldn’t do so States. Section 7701(b) and its regulations
as a student if you were exempt as a because of a medical condition or medical require that you give us the information.
teacher, trainee, or student for any part of problem that arose while you were in the We need it to determine if you can exclude
more than 5 calendar years unless you United States. Whether you intended to days of presence in the United States for
establish that you don’t intend to reside leave the United States on a particular day purposes of the substantial presence test.
permanently in the United States. The facts is determined based on all the facts and You aren’t required to provide the
and circumstances to be considered in circumstances. For more details, see Pub. information requested on a form that is
determining if you have established that 519. subject to the Paperwork Reduction Act
you don’t intend to reside permanently in If you qualify to exclude days of unless the form displays a valid OMB
the United States include, but aren’t limited presence because of a medical condition control number. Books or records relating
to: or medical problem, complete Part I and to a form or its instructions must be
1. Whether you have maintained a closer lines 17a through 17c of Part V. Have your retained as long as their contents may
connection to a foreign country than to the physician or other medical official complete become material in the administration of
United States (for details, see Pub. 519), line 18. any Internal Revenue law. Generally, tax
returns and return information are
and Note: You cannot exclude any days of confidential, as required by section 6103.
2. Whether you have taken affirmative presence in the United States under any of
steps to change your status from the following circumstances. The average time and expenses required
to complete and file this form will vary
nonimmigrant to lawful permanent resident. • You entered or returned to the United depending on individual circumstances.
If you qualify to exclude days of States for medical treatment. It does not For the estimated averages, see the
presence as a student, complete Parts I matter whether you intended to leave the instructions for your income tax return.
and III of Form 8843. If you have a “Q” United States immediately after the
visa, complete Part I and only lines 10 medical treatment but couldn’t do so If you have suggestions for making this
through 14 of Part III. On line 10, enter the because of unforeseen complications from form simpler, we would be happy to hear
name, address, and telephone number of the medical treatment. from you. See the instructions for your
the director of the cultural exchange income tax return.
program in which you participated.

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