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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.
2021
▶ Go to www.irs.gov/Form8843 for the latest information.
Attachment
Department of the Treasury For the year January 1—December 31, 2021, or other tax year Sequence No. 102
Internal Revenue Service beginning , 2021, 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:
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)

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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        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 (2021)

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Form 8843 (2021) Page 3
General Instructions Substantial Presence Test The term “exempt individual” also
Section references are to the Internal You are considered a U.S. resident if you includes an individual temporarily present
Revenue Code unless otherwise specified. meet the substantial presence test for in the United States as a foreign
2021. You meet this test if you were government-related individual under an “A”
Future Developments physically present in the United States for or “G” visa, other than individuals holding
For the latest information about at least: “A-3” or “G-5” class visas. An individual
present under an “A-3” or “G-5” class visa
developments related to Form 8843 and its • 31 days during 2021; and is not considered a foreign government-
instructions, such as legislation enacted • 183 days during the period 2021, 2020, related individual and must count all his or
after they were published, go to and 2019, counting all the days of physical her days of presence in the United States
www.irs.gov/Form8843. presence in 2021 but only 1/3 the number for purposes of the substantial presence
What’s New of days of presence in 2020 and only 1/6 test. For more details, see Pub. 519. If you
COVID-19 Medical Condition Travel the number of days in 2019. are present under any other “A” or “G”
Exception (Rev. Proc. 2020-20 Note: To claim the closer connection to a class visa, you are not required to file Form
Exception). For tax year 2021, individuals foreign country(ies) exception to the 8843.
cannot claim the COVID-19 medical substantial presence test described in
condition travel exception to exclude any Regulations section 301.7701(b)-2, you Specific Instructions
days of presence in the United States for must file Form 8840. Part I—General Information
the purpose of the “substantial presence Days of presence in the United States. If you are attaching Form 8843 to Form
test.” However, days of presence in the Generally, you are treated as being present 1040-NR, you aren’t required to complete
United States in 2020 that were excluded in the United States on any day that you lines 1a through 4a of Form 8843 if you
for tax year 2020 may impact the are physically present in the country at any provide the requested information on the
application of the “substantial presence time during the day. However, you don’t corresponding lines of Form 1040-NR. See
test” for tax year 2021. For more count the following days of presence in the Schedule OI of those forms.
information, see Days of presence in the United States for purposes of the
United States, later. substantial presence test. In this case, enter “Information provided
on Form 1040-NR” on line 1a of Form
Who Must File 1. Days you regularly commuted to work 8843. Complete line 4b and the rest of
If you are an alien individual (other than a in the United States from a residence in Form 8843.
foreign government-related individual), you Canada or Mexico.
If Form 8843 is filed separately, you must
must file Form 8843 to explain the basis of 2. Days you were in the United States for complete all entries on the form.
your claim that you can exclude days of less than 24 hours when you were traveling
presence in the United States for purposes between two places outside the United Line 1b. Enter your current nonimmigrant
of the substantial presence test because States. status, such as that shown on your current
Immigration Form I-94, Arrival-Departure
you: 3. Days you were temporarily in the Record. If your status has changed while in
• Were an exempt individual, or United States as a regular crew member of the United States, enter the date of change
a foreign vessel engaged in transportation and previous status.
• Were unable to leave the United States between the United States and a foreign
because of a medical condition or medical country or a possession of the United Part II—Teachers and Trainees
problem. States unless you otherwise engaged in A teacher or trainee is an individual who is
When and Where To File trade or business on such a day. temporarily present in the United States
If you are filing a 2021 Form 1040-NR, 4. Days you were unable to leave the under a “J” or “Q” visa (other than as a
attach Form 8843 to it. Mail your tax return United States because of a medical student) and who substantially complies
by the due date (including extensions) to condition or medical problem that arose with the requirements of the visa.
the address shown in your tax return while you were in the United States. If you were a teacher or trainee under a
instructions. 5. Days you were an exempt individual. “J” or “Q” visa, you are considered to have
If you don’t have to file a 2021 tax return, Note: For more information on determining substantially complied with the visa
mail Form 8843 to the Department of the resident alien or nonresident alien status requirements if you haven’t engaged in
Treasury, Internal Revenue Service Center, under the “substantial presence test” as a activities that are prohibited by U.S.
Austin, TX 73301-0215 by the due date result of having applied the COVID-19 immigration laws that could result in the
(including extensions) for filing Form Medical Condition Travel Exception to loss of your “J” or “Q” visa status.
1040-NR. exclude days of presence in the United Even if you meet these requirements,
Penalty for Not Filing Form 8843 States in 2020, see Rev. Proc. 2020-20, you can’t exclude days of presence in 2021
2020-20 I.R.B. 801, available at www.irs. as a teacher or trainee if you were exempt
If you don’t file Form 8843 on time, you gov/irb/2020-20_IRB#REV-PROC-2020-20. as a teacher, trainee, or student for any
may not exclude the days you were part of 2 of the 6 prior calendar years. But
present in the United States as a Exempt Individuals see the Exception below.
professional athlete or because of a For purposes of the substantial presence If you qualify to exclude days of
medical condition or medical problem that test, an exempt individual includes anyone presence as a teacher or trainee, complete
arose while you were in the United States. in the following categories. Parts I and II of Form 8843. If you have a
Failure to exclude days of presence in the • A teacher or trainee (defined on this “Q” visa, complete Part I and only lines 6
United States could result in your being page). through 8 of Part II. On line 6, enter the
considered a U.S. resident under the name, address, and telephone number of
substantial presence test. • A student (defined on the next page).
You won’t be penalized if you can show • A professional athlete temporarily present the director of the cultural exchange
by clear and convincing evidence that you in the United States to compete in a program in which you participated.
took reasonable actions to become aware charitable sports event.
of the filing requirements and significant
steps to comply with those requirements.

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Form 8843 (2021) Page 4
Exception. If you were exempt as a 1. Whether you have maintained a closer • You were initially prevented from leaving,
teacher, trainee, or student for any part of 2 connection to a foreign country than to the were then able to leave, but remained in
of the 6 prior calendar years, you can United States (for details, see Pub. 519), the United States beyond a reasonable
exclude days of presence in 2021 as a and period for making arrangements to leave.
teacher or trainee only if all four of the 2. Whether you have taken affirmative • You entered or returned to the United
following apply. steps to change your status from States for medical treatment. It does not
1. You were exempt as a teacher, nonimmigrant to lawful permanent resident. matter whether you intended to leave the
trainee, or student for any part of 3 (or If you qualify to exclude days of United States immediately after the
fewer) of the 6 prior calendar years. presence as a student, complete Parts I medical treatment but couldn’t do so
2. A foreign employer paid all your and III of Form 8843. If you have a “Q” because of unforeseen complications from
compensation during 2021. visa, complete Part I and only lines 10 the medical treatment.
3. You were present in the United States through 14 of Part III. On line 10, enter the • The medical condition existed before
as a teacher or trainee in any of the 6 prior name, address, and telephone number of your arrival in the United States and you
years. the director of the cultural exchange were aware of the condition. It does not
4. A foreign employer paid all of your program in which you participated. matter whether you needed treatment for
the condition when you entered the United
compensation during each of those prior 6 Part IV—Professional Athletes States.
years you were present in the United A professional athlete is an individual who Paperwork Reduction Act Notice. We
States as a teacher or trainee. is temporarily present in the United States ask for the information on this form to carry
For more details, see Pub. 519. to compete in a charitable sports event. out the Internal Revenue laws of the United
If you meet this exception, you must For details on charitable sports events, see States. Section 7701(b) and its regulations
attach information to verify that a foreign Pub. 519. require that you give us the information.
employer paid all the compensation you If you qualify to exclude days of We need it to determine if you can exclude
received in 2021 and all prior years that presence as a professional athlete, days of presence in the United States for
you were present in the United States as a complete Parts I and IV of Form 8843. purposes of the substantial presence test.
teacher or trainee.
Part V—Individuals With a Medical You aren’t required to provide the
Part III—Students Condition or Medical Problem information requested on a form that is
subject to the Paperwork Reduction Act
A student is an individual who is For purposes of the substantial presence unless the form displays a valid OMB
temporarily present in the United States test, don’t count the days you intended to control number. Books or records relating
under an “F,” “J,” “M,” or “Q” visa and who leave the United States but couldn’t do so to a form or its instructions must be
substantially complies with the because of a medical condition or medical retained as long as their contents may
requirements of the visa. problem that arose while you were in the become material in the administration of
If you were a student under an “F,” “J,” United States. Whether you intended to any Internal Revenue law. Generally, tax
“M,” or “Q” visa, you are considered to leave the United States on a particular day returns and return information are
have substantially complied with the visa is determined based on all the facts and confidential, as required by section 6103.
requirements if you haven’t engaged in circumstances. For more details, see Pub.
activities that are prohibited by U.S. 519. The average time and expenses required
to complete and file this form will vary
immigration laws and could result in the If you qualify to exclude days of depending on individual circumstances.
loss of your visa status. presence because of a medical condition For the estimated averages, see the
Even if you meet these requirements, or medical problem, complete Part I and instructions for your income tax return.
you can’t exclude days of presence in 2021 lines 17a through 17c of Part V. Have your
as a student if you were exempt as a physician or other medical official complete If you have suggestions for making this
teacher, trainee, or student for any part of line 18. form simpler, we would be happy to hear
from you. See the instructions for your
more than 5 calendar years unless you Note: You cannot exclude any days of income tax return.
establish that you don’t intend to reside presence in the United States under any of
permanently in the United States. The facts the following circumstances.
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:

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