OMB No. 1545-0074
                                    Credits for Sick Leave and Family Leave  
Form  7202                             for Certain Self-Employed Individuals
Department of the Treasury                      ▶ Attach to Form 1040, 1040-SR, or 1040-NR.                                 Attachment  2021
Internal Revenue Service          ▶ Go to www.irs.gov/Form7202 for instructions and the latest information.                 Sequence No. 202
Name of person with self-employment income (as shown on Form 1040, 1040-SR, or 1040-NR)                   Social security number of person with 
                                                                                                          self-employment income

Part I        Credit for Sick Leave for Certain Self-Employed Individuals (January 1, 2021, through March 31, 2021, only)
1     Number of days after December 31, 2020, and before April 1, 2021, you were unable to perform services as 
      a self-employed individual because of certain coronavirus-related care you required. See instructions  .  .        1 
2     Number of days after December 31, 2020, and before April 1, 2021, you were unable to perform services as 
      a  self-employed  individual  because  of  certain  coronavirus-related  care  you  provided  to  another.  (Don’t 
      include days you included on line 1.) See instructions  .  . .   . . .            . . . . . . .   . .   . .        2 
3 a   Enter the number from line 4 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, enter -0-  .  . .        3a
b     Enter the number from line 6 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, enter -0-  .  . .        3b
c     Add lines 3a and 3b .     . . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        3c
d     Subtract line 3c from the number 10       . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        3d
4 a   Enter the smaller of line 1 or line 3d  . . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        4a
b     List each day included on line 4a (MM/DD): 
5     Subtract line 4a from line 3d  . .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        5 
6 a   Enter the smaller of line 2 or line 5 .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        6a
b     List each day included on line 6a (MM/DD): 
      Caution: The total of line 4a plus line 6a cannot exceed 10 days or line 3d, whichever is smaller.
7 a   Net earnings from self-employment (see instructions)  .    . .   . . .            . . . . . . .   . .   . .        7a
b     Check this box if you are electing to use prior year net earnings from self-employment on line 7a . .   ▶
8     Divide line 7a by 260 (round to nearest whole number)  .   . .   . . .            . . . . . . .   . .   . .        8 
9     Enter the smaller of line 8 or $511   .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        9 
10    Multiply line 4a by line 9  . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        10 
11    Multiply line 8 by 67% (0.67)  . .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        11 
12    Enter the smaller of line 11 or $200 .    . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        12 
13    Multiply line 6a by line 12 . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        13 
14    Add lines 10 and 13 .     . . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        14 
15 a  Amount of qualified sick leave wages subject to the $511 per day limit you received from an employer for 
      periods of leave taken after December 31, 2020, and before April 1, 2021 (see instructions)   .   . .   . .        15a 
b     Enter the amount from line 15 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, see instructions 
      for amount to enter  .    . . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        15b
c     Add lines 15a and 15b  .    . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        15c
16 a  Amount of qualified sick leave wages subject to the $200 per day limit you received from an employer for 
      periods of leave taken after December 31, 2020, and before April 1, 2021 (see instructions)   .   . .   . .        16a 
b     Enter the amount from line 16 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, see instructions 
      for amount to enter  .    . . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        16b
c     Add lines 16a and 16b  .    . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        16c
      If line 15c and line 16c are both zero, skip to line 24 and enter the amount from line 14.
17 a  Add lines 13 and 16c      . . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        17a 
b     Enter the amount from line 13 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, enter -0-    . .        17b
c     Add lines 17a and 17b  .    . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        17c
18    Enter the smaller of line 17c or $2,000  .  . . .  .  .    . .   . . .            . . . . . . .   . .   . .        18 
19    Subtract line 18 from line 17c . .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        19 
20 a  Add lines 10, 15c, and 18 .   .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        20a 
b     Enter the amount from line 10 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, enter -0-    . .        20b
c     Add lines 20a and 20b  .    . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        20c
21    Enter the smaller of line 20c or $5,110 .   . . .  .  .    . .   . . .            . . . . . . .   . .   . .        21 
22    Subtract line 21 from line 20c . .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        22 
23    Add lines 19 and 22 .     . . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        23 
24    Subtract line 23 from line 14. If zero or less, enter -0-. Enter here and include on Schedule 3 (Form 1040), 
      line 13b    .      .  . . . . .  .    .   . . . .  .  .    . .   . . .            . . . . . . .   . .   . .        24 
For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions.             Cat. No. 56395K            Form 7202 (2021) 

Form 7202 (2021)                                                                                                                    Page 2
Part II  Credit for Family Leave for Certain Self-Employed Individuals (January 1, 2021, through March 31, 2021, only)
25 a Number of days after December 31, 2020, and before April 1, 2021, you were unable to perform services as 
     a self-employed individual because of certain coronavirus-related care you provided to a son or daughter. 
     (Don’t enter more than 50 days. Don’t include any day you listed on either line 4b or line 6b.) See instructions      25a
b    Enter the amount from line 25 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, enter -0-     . .          25b
c    Subtract line 25b from the number 50  .      . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          25c
d    Enter the smaller of line 25a or line 25c  . . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          25d
26 a Net earnings from self-employment (see instructions)  .    . . .    .  . . . . . .      .  .      .   .  . .          26a 
b    Check this box if you are electing to use prior year net earnings from self-employment on line 26a  . .  ▶
27   Divide line 26a by 260 (round to nearest whole number) .   . . .    .  . . . . . .      .  .      .   .  . .          27 
28   Multiply line 27 by 67% (0.67) .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          28 
29   Enter the smaller of line 28 or $200 .   .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          29 
30   Multiply line 25d by line 29   .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          30 
31 a Amount  of  qualified  family  leave  wages  you  received  from  an  employer  for  periods  of  leave  taken  after 
     December 31, 2020, and before April 1, 2021 (see instructions) .    .  . . . . . .      .  .      .   .  . .          31a
b    Enter the amount from line 31 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, see instructions 
     for amount to enter  . . .     .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          31b
c    Add lines 31a and 31b  . .     .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          31c
     If line 31c is zero, skip to line 35 and enter the amount from line 30.
32 a Add lines 30 and 31c   . .     .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          32a 
b    Enter the amount from line 30 of your 2020 Form 7202. If you didn’t file a 2020 Form 7202, enter -0-     . .          32b
c    Add lines 32a and 32b  . .     .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          32c
33   Enter the smaller of line 32c or $10,000 .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          33 
34   Subtract line 33 from line 32c  . . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          34 
35   Subtract line 34 from line 30. If zero or less, enter -0-. Enter here and include on Schedule 3 (Form 1040), line 13b 35 
Part III Credit for Sick Leave for Certain Self-Employed Individuals (April 1, 2021, through September 30, 2021, only)
36   Number of days after March 31, 2021, and before October 1, 2021, you were unable to perform services as 
     a self-employed individual because of certain coronavirus-related care you required. See instructions  .   .          36
37   Number of days after March 31, 2021, and before October 1, 2021, you were unable to perform services as 
     a  self-employed  individual  because  of  certain  coronavirus-related  care  you  provided  to  another.  (Don’t 
     include days you included on line 36.) See instructions  . . . .    .  . . . . . .      .  .      .   .  . .          37
38 a Enter the smaller of 10 days or the number of days entered on line 36  . . . . . .      .  .      .   .  . .          38a
b    List each day included on line 38a (MM/DD): 
39   Subtract line 38a from the number 10  .      . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          39
40a  Enter the smaller of line 37 or line 39. .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          40a
b    List each day included on line 40a (MM/DD): 
     Caution: The total of line 38a plus line 40a cannot exceed 10 days. 
41a  Net earnings from self-employment (see instructions) .     . . .    .  . . . . . .      .  .      .   .  . .          41a
b    Check this box if you are electing to use prior year net earnings from self-employment on line 41a .  .  ▶
42   Divide line 41a by 260 (round to nearest whole number)     . . .    .  . . . . . .      .  .      .   .  . .          42
43   Enter the smaller of line 42 or $511  .  .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          43
44   Multiply line 38a by line 43 . .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          44
45   Multiply line 42 by 67% (0.67) .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          45
46   Enter the smaller of line 45 or $200 .   .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          46
47   Multiply line 40a by line 46 . .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          47
48   Add lines 44 and 47 .  . .     .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          48
49   Amount of qualified sick leave wages subject to the $511 per day limit you received from an employer for 
     periods of leave taken after March 31, 2021, and before October 1, 2021 (see instructions) .      .   .  . .          49
50   Amount of qualified sick leave wages subject to the $200 per day limit you received from an employer for 
     periods of leave taken after March 31, 2021, and before October 1, 2021 (see instructions) .      .   .  . .          50
     If line 49 and line 50 are both zero, skip to line 58 and enter the amount from line 48.
51   Add lines 47 and 50 .  . .     .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          51
52   Enter the smaller of line 51 or $2,000   .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          52
53   Subtract line 52 from line 51  .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          53
54   Add lines 44, 49, and 52 .     .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          54
55   Enter the smaller of line 54 or $5,110   .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          55
56   Subtract line 55 from line 54 .   . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          56
57   Add lines 53 and 56 .  . .     .  . .    .   . . . . .     . . .    .  . . . . . .      .  .      .   .  . .          57
58   Subtract line 57 from line 48. If zero or less, enter -0-. Enter here and include on Schedule 3 (Form 1040), line 13h 58
                                                                                                                               Form 7202 (2021) 

Form 7202 (2021)                                                                                                                   Page 3
Part IV Credit for Family Leave for Certain Self-Employed Individuals (April 1, 2021, through September 30, 2021, only)
59  Number of days after March 31, 2021, and before October 1, 2021, you were unable to perform services as a 
    self-employed  individual  because  of  certain  coronavirus-related  care  you  required  or  provided  to  another. 
    (Don’t enter more than 60 days. Don’t include any day you listed on either line 38b or line 40b.) See instructions    59
60a Net earnings from self-employment (see instructions)  .  . .  . .     . . . . . . . .             .   .  . .          60a 
b   Check this box if you are electing to use prior year net earnings from self-employment on line 60a  . .  ▶
61  Divide line 60a by 260 (round to nearest whole number) . . .  . .     . . . . . . . .             .   .  . .          61
62  Multiply line 61 by 67% (0.67) . . .   .   . . . . .     . .  . .     . . . . . . . .             .   .  . .          62
63  Enter the smaller of line 62 or $200 . .   . . . . .     . .  . .     . . . . . . . .             .   .  . .          63
64  Multiply line 59 by line 63  . . . .   .   . . . . .     . .  . .     . . . . . . . .             .   .  . .          64
65  Amount  of  qualified  family  leave  wages  you  received  from  an  employer  for  periods  of  leave  taken  after 
    March 31, 2021, and before October 1, 2021 (see instructions) . .     . . . . . . . .             .   .  . .          65
    If line 65 is zero, skip to line 69 and enter the amount from line 64.
66  Add lines 64 and 65 . . .      . . .   .   . . . . .     . .  . .     . . . . . . . .             .   .  . .          66
67  Enter the smaller of line 66 or $12,000  . . . . . .     . .  . .     . . . . . . . .             .   .  . .          67
68  Subtract line 67 from line 66 .  . .   .   . . . . .     . .  . .     . . . . . . . .             .   .  . .          68
69  Subtract line 68 from line 64. If zero or less, enter -0-. Enter here and include on Schedule 3 (Form 1040), 
    line 13h     . . . .  . .      . . .   .   . . . . .     . .  . .     . . . . . . . .             .   .  . .          69
                                                                                                                              Form 7202 (2021)