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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.
2023
Go to www.irs.gov/Form8843 for the latest information.
Attachment
Department of the Treasury For the year January 1—December 31, 2023, or other tax year Sequence No. 102
Internal Revenue Service beginning , 2023, and ending , 20 .
Your first name and initial Last name Your U.S. taxpayer identification number (TIN), 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 U.S.
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:
2023 2022 2021
b Enter the number of days in 2023 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 2023:

6 For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program you
participated in during 2023:

7 Enter the type of U.S. visa (J or Q) you held during: 2017 2018
2019 2020 2021 2022 . 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 exempt as a teacher, trainee, or student for any part of 2 of the preceding 6 calendar years (2017
through 2022)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 2023:

10 Enter the name, address, and telephone number of the director of the academic or other specialized program you participated
in during 2023:

11 Enter the type of U.S. visa (F, J, M, or Q) you held during: 2017 2018
2019 2020 2021 2022 . 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 exempt 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 2023, 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 (2023)

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Form 8843 (2023)                                                                                               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 2023 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 their 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 U.S. tax 
return.                                               Your signature                                      Date
                                                                                                          Form 8843 (2023)

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Form 8843 (2023) Page 3
Section references are to the Internal Days of presence in the United States. In this case, enter “Information provided
Revenue Code unless otherwise specified. Generally, you are treated as being present on Form 1040-NR” on line 1a of Form
in the United States on any day that you 8843. Complete line 4b and the rest of
Future Developments are physically present in the country at any Form 8843.
For the latest information about time during the day. However, you don’t If Form 8843 is filed separately, you must
developments related to Form 8843 and its count the following days of presence in the complete all entries on the form.
instructions, such as legislation enacted United States for purposes of the Line 1a. Enter your nonimmigrant visa type
after they were published, go to substantial presence test. (for example, F-1, F-2, J-1, J-2, H1-B, etc.)
www.irs.gov/Form8843. 1. Days you regularly commuted to work and the corresponding date of the most
in the United States from a residence in recent entry to the United States. See your
General Instructions Canada or Mexico. USCIS Form I-94, Arrival-Departure
Who Must File 2. Days you were in the United States for Record.
If you are an alien individual (other than a less than 24 hours when you were traveling Line 1b. Enter your current nonimmigrant
foreign government-related individual), you between two places outside the United status, as of the last day of the tax year,
must file Form 8843 to explain the basis of States. such as that shown on your current USCIS
your claim that you can exclude days of 3. Days you were temporarily in the Form I-94. Usually, this is the same as your
presence in the United States for purposes United States as a regular crew member of entry on line1a, unless you changed your
of the substantial presence test because a foreign vessel engaged in transportation status while in the United States since your
you: between the United States and a foreign last entry. If your status has changed while
• Were an exempt individual, or country or a territory of the United States in the United States (for example, you
unless you otherwise engaged in trade or entered with a B-1 or B-2 visitor visa and
• Were unable to leave the United States business on such a day. without leaving, you changed to an F-1 or
because of a medical condition or medical 4. Days you were unable to leave the M-1 student visa status), enter the date of
problem. United States because of a medical change and previous status. See USCIS
When and Where To File condition or medical problem that arose Form I-797, Notice of Action, for
If you are filing a 2023 Form 1040-NR, while you were in the United States. information on the date that your change of
attach Form 8843 to it. Mail your tax return 5. Days you are in the United States status was approved.
by the due date (including extensions) to under a NATO visa as a member of a force Part II—Teachers and Trainees
the address shown in your tax return or civilian component to NATO. However, A teacher or trainee is an individual who is
instructions. this exception does not apply to an temporarily present in the United States
If you don’t have to file a 2023 tax return, immediate family member who is present in under a “J” or “Q” visa (other than as a
mail Form 8843 to the Department of the the United States under a NATO visa. A student) and who substantially complies
Treasury, Internal Revenue Service Center, dependent family member must count with the requirements of the visa.
Austin, TX 73301-0215 by the due date every day of presence for purposes of the
(including extensions) for filing Form substantial presence test. If you were a teacher or trainee under a
“J” or “Q” visa, you are considered to have
1040-NR. 6. Days you were an exempt individual. substantially complied with the visa
Penalty for Not Filing Form 8843 Exempt Individuals requirements if you haven’t engaged in
activities that are prohibited by U.S.
If you don’t file Form 8843 on time, you For purposes of the substantial presence immigration laws that could result in the
may not exclude the days you were test, an exempt individual includes anyone loss of your “J” or “Q” visa status.
present in the United States as a in the following categories.
Even if you meet these requirements,
professional athlete or because of a • A teacher or trainee (defined on this you can’t exclude days of presence in 2023
medical condition or medical problem that page). as a teacher or trainee if you were exempt
arose while you were in the United States. • A student (defined on the next page). as a teacher, trainee, or student for any
Failure to exclude days of presence in the
United States could result in your being • A professional athlete temporarily present part of 2 of the 6 prior calendar years. But
considered a U.S. resident under the in the United States to compete in a see the Exception , later.
substantial presence test. charitable sports event. If you qualify to exclude days of
You won’t be penalized if you can show The term “exempt individual” also presence as a teacher or trainee, complete
by clear and convincing evidence that you includes an individual temporarily present Parts I and II of Form 8843. If you have a
took reasonable actions to become aware in the United States as a foreign “Q” visa, complete Part I and only lines 6
of the filing requirements and significant government-related individual under an “A” through 8 of Part II. On line 6, enter the
steps to comply with those requirements. or “G” visa, other than individuals holding name, address, and telephone number of
“A-3” or “G-5” class visas. An individual the director of the cultural exchange
Substantial Presence Test present under an “A-3” or “G-5” class visa program in which you participated.
You are considered a U.S. resident if you is not considered a foreign government- Exception. If you were exempt as a
meet the substantial presence test for related individual and must count all their teacher, trainee, or student for any part of 2
2023. You meet this test if you were days of presence in the United States for of the 6 prior calendar years, you can
physically present in the United States for purposes of the substantial presence test. exclude days of presence in 2023 as a
at least: For more details, see Pub. 519. If you are teacher or trainee only if all four of the
• 31 days during 2023; and present under any other “A” or “G” class following apply.
visa, you are not required to file Form 8843.
• 183 days during the period 2023, 2022, 1. You were exempt as a teacher,
trainee, or student for any part of 3 (or
and 2021, counting all the days of physical Specific Instructions fewer) of the 6 prior calendar years.
presence in 2023 but only 1/3 the number
of days of presence in 2022 and only 1/6 Part I—General Information 2. A foreign employer paid all your
the number of days in 2021. If you are attaching Form 8843 to Form compensation during 2023.
Note: To claim the closer connection to a 1040-NR, you aren’t required to complete 3. You were present in the United States
foreign country(ies) exception to the lines 1a through 4a of Form 8843 if you as a teacher or trainee in any of the 6 prior
substantial presence test described in provide the requested information on the years.
Regulations section 301.7701(b)-2, you corresponding lines of Form 1040-NR. See 4. A foreign employer paid all of your
must file Form 8840. Schedule OI of those forms. compensation during each of those prior 6
years you were present in the United
States as a teacher or trainee.

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Form 8843 (2023) Page 4
For more details, see Pub. 519. Part IV—Professional Athletes Paperwork Reduction Act Notice. We
If you meet this exception, you must A professional athlete is an individual who ask for the information on this form to carry
attach information to verify that a foreign is temporarily present in the United States out the Internal Revenue laws of the United
employer paid all the compensation you to compete in a charitable sports event. States. Section 7701(b) and its regulations
received in 2023 and all prior years that For details on charitable sports events, see require that you give us the information.
you were present in the United States as a Pub. 519. We need it to determine if you can exclude
days of presence in the United States for
teacher or trainee. If you qualify to exclude days of purposes of the substantial presence test.
presence as a professional athlete,
Part III—Students complete Parts I and IV of Form 8843. You aren’t required to provide the
A student is an individual who is information requested on a form that is
temporarily present in the United States Part V—Individuals With a Medical subject to the Paperwork Reduction Act
under an “F,” “J,” “M,” or “Q” visa and who Condition or Medical Problem unless the form displays a valid OMB
substantially complies with the For purposes of the substantial presence control number. Books or records relating
requirements of the visa. test, don’t count the days you intended to to a form or its instructions must be
If you were a student under an “F,” “J,” leave the United States but couldn’t do so retained as long as their contents may
“M,” or “Q” visa, you are considered to because of a medical condition or medical become material in the administration of
have substantially complied with the visa problem that arose while you were in the any Internal Revenue law. Generally, tax
requirements if you haven’t engaged in United States. Whether you intended to returns and return information are
activities that are prohibited by U.S. leave the United States on a particular day confidential, as required by section 6103.
immigration laws and could result in the is determined based on all the facts and The average time and expenses required
loss of your visa status. circumstances. For more details, see Pub. to complete and file this form will vary
Even if you meet these requirements, 519. depending on individual circumstances.
you can’t exclude days of presence in 2023 If you qualify to exclude days of For the estimated averages, see the
as a student if you were exempt as a presence because of a medical condition instructions for your income tax return.
teacher, trainee, or student for any part of or medical problem, complete Part I and If you have suggestions for making this
more than 5 calendar years unless you lines 17a through 17c of Part V. Have your form simpler, we would be happy to hear
establish that you don’t intend to reside physician or other medical official complete from you. See the instructions for your
permanently in the United States. The facts line 18. income tax return.
and circumstances to be considered in Note: You cannot exclude any days of
determining if you have established that presence in the United States under any of
you don’t intend to reside permanently in the following circumstances.
the United States include, but aren’t limited • You entered or returned to the United
to: States for medical treatment. It does not
1. Whether you have maintained a closer matter whether you intended to leave the
connection to a foreign country than to the United States immediately after the
United States (for details, see Pub. 519), medical treatment but couldn’t do so
and because of unforeseen complications from
2. Whether you have taken affirmative the medical treatment.
steps to change your status from
nonimmigrant to lawful permanent resident. • The medical condition existed before
If you qualify to exclude days of your arrival in the United States and you
presence as a student, complete Parts I were aware of the condition. It does not
and III of Form 8843. If you have a “Q” matter whether you needed treatment for
visa, complete Part I and only lines 10 the condition when you entered the United
through 14 of Part III. On line 10, enter the States.
name, address, and telephone number of • You were initially prevented from leaving,
the director of the cultural exchange were then able to leave, but remained in
program in which you participated. the United States beyond a reasonable
period for making arrangements to leave.

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