Form 1040-SS                                                                                          U.S. Self-Employment Tax Return                                                                    OMB No. 1545-0074 
                                                            (Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico)
Department of the Treasury                                  U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, or Puerto Rico
Internal Revenue Service                                   For the year Jan. 1–Dec. 31, 2023, or other tax year beginning                 , 2023, and ending         , 20                                  2023
                                          Your first name and initial                                             Last name                                                  Your social security number 

                                          If a joint return, spouse’s first name and initial                      Last name                                                  Spouse’s social security number 

                                          Home address (number, street, and apt. no., or rural route) 

                                          City, town or post office, commonwealth or territory, and ZIP code 
                     Please type or print.
                                          Foreign country name                                                                     Foreign province/state/county                                          Foreign postal code       

At  any  time  during  2023,  did  you:  (a)  receive  (as  a  reward,  award,  or  payment  for  property  or  services);  or  (b)  sell,  exchange,  or 
otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions)  .                                                         . . .       .     .                   .   .   Yes   No
Part I                                      Total Tax and Credits 
1                                           Filing status. Check the box for your filing status. See instructions. 
                                            Single     Married filing jointly                             Married filing separately (MFS)     Head of household              Qualifying surviving spouse
                                            If you checked the MFS box, enter spouse’s social security no. above and full name here:
2                                           Qualifying children.        Complete only if you are a bona fide resident of Puerto Rico and you are claiming the additional child tax 
                                            credit. See instructions. If more than four qualifying children, see instructions and check here  .                      .       .     .                   .   . . . . .
                                            (a) First name                      Last name                              (b) Child’s social security number          (c) Child’s relationship to you 

3                                           Self-employment  tax  from  Schedule  SE  (Form  1040),  line  12.  Attach  applicable  schedules  (see 
                                            instructions) . .         . . . .   .                     . . . . . . .    .  . .      . .    . . . . .          . . . . .       .                         3 
4                                           Household employment taxes (see instructions). Attach Schedule H (Form 1040)  .                                  . . . . .       .                         4 
5                                           Additional Medicare Tax. Attach Form 8959                         . . .    .  . .      . .    . . . . .          . . . . .       .                         5
6                                           Total tax. Add lines 3 through 5. See instructions                    .    .  . .      . .    . . . . .          . . . . .       .                         6
7                                           2023 estimated tax payments (see instructions)  .                     .    .  . .      . .    . . .   7
8                                           Excess social security tax withheld (see instructions)   .                    . .      . .    . . .   8
9                                           Additional child tax credit from Part II, line 19  .                . .    .  . .      . .    . . .   9
10                                          Reserved for future use       . .   .                     . . . . . . .    .  . .      . .    . . .   10
11 a                                        Credit  for  qualified  sick  and  family  leave  wages  from  Schedule(s)  H  paid  in
                                            2023 for leave taken before April 1, 2021                       . . . .    .  . .      . .    . . .   11a
                                          b Credit  for  qualified  sick  and  family  leave  wages  from  Schedule(s)  H  paid  in
                                            2023 for leave taken after March 31, 2021, and before October 1, 2021  .                          .   11b
12                                          Total payments and credits (see instructions)                       . .    .  . .      . .    . . . . .          . . . . .       .                         12 
13                                          If line 12 is more than line 6, subtract line 6 from line 12. This is the amount you overpaid                        . . .       .                         13
14a                                         Amount of line 13 you want refunded to you. If Form 8888 is attached, check here  .                                . . . .                                 14a 
                                          b Routing number                                                                         c Type:      Checking           Savings
                                          d Account number
15                                          Amount of line 13 you want applied to 2024 estimated tax                        .      . .    . . .   15
16                                          Amount you owe. If line 6 is more than line 12, subtract line 12 from line 6. See instructions  .                        .       .                         16
                                            Do you want to allow another person to discuss this return with the IRS? See instructions.                             Yes. Complete the following.                      No
Third Party 
Designee                                    Designee’s                                                                      Phone                                Personal identification 
                                            name                                                                            no.                                  number (PIN)           
                                            Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, 
Sign                                        they are true, correct, and complete. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.
Here                                        Your signature                                                        Date               Daytime phone number      If the IRS sent you an Identity Protection PIN, 
                                                                                                                                                               enter it here 
Joint return?                                                                                                                                                  (see instructions) 
See instructions.                           Spouse’s signature. If a joint return, both must sign.                                   Date                      If the IRS sent your spouse an Identity Protection 
Keep a copy                                                                                                                                                    PIN, enter it here 
for your records.                                                                                                                                              (see instructions) 
                                            Print/Type preparer’s name                                        Preparer’s signature                        Date               Check          if               PTIN
Paid                                                                                                                                                                         self-employed
Preparer                                    Firm’s name                                                                                                              Firm’s EIN
Use Only                                    Firm’s address                                                                                                           Phone no.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice,                                                                   www.irs.gov/Form1040SS      Cat. No. 17184B                          Form 1040-SS (2023)
see instructions. 

Form 1040-SS (2023)                                                                                                    Page 2 
Part II Bona Fide Residents of Puerto Rico Claiming Additional Child Tax Credit—See instructions.
1    Do you have one or more qualifying children under age 17 with the required social security number?
        No. Stop. You can’t claim the credit.
        Yes. Go to line 2.
2    Number of qualifying children under age 17 with the required social security number:
                          x  $1,600. Enter the result  . . .    . . .    . . . .   . .            .  . . . . . . 2
3    Enter your modified adjusted gross income  .     .  . .    . . .    . . . .   .              3
4    Enter the amount shown below for your filing status  .     . . .    . . . .   .              4
     • Married filing jointly – $400,000
     • All other filing statuses – $200,000
5    Is the amount on line 3 more than the amount on line 4?
        No. Leave line 5 blank. Enter the amount from line 2 on line 11, and go to 
        line 12.
        Yes.  Subtract  line  4  from  line  3.  If  the  result  isn’t  a  multiple  of  $1,000, 
        increase  it  to  the  next  multiple  of  $1,000  (for  example,  increase  $425  to 
        $1,000, increase $1,025 to $2,000, etc.)      .  . .    . . .    . . . .   .              5
6    Multiply the amount on line 5 by 5% (0.05). Enter the result  .     . . . .   . .            .  . . . . . . 6
7    Number of qualifying children from line 2 x $2,000. Enter the result  . . .   .              7
8    Number of other dependents, including children who are not under age 17:
                          x  $500. Enter the result. See instructions  . . . . .   .              8
9    Add lines 7 and 8  .   . . .  .    .  .   . .    .  . .    . . .    . . . .   .              9
10   Is the amount on line 9 more than the amount on line 6?
        No. Stop. You can’t claim the credit.
        Yes. Subtract line 6 from line 9. Enter the result  .   . . .    . . . .   . .            .  . . . . . . 10 
11   Enter the smaller of line 2 or line 10  . . .    .  . .    . . .    . . . .   . .            .  . . . . . . 11 
12a  Enter one-half of self-employment tax from Part I, line 3    . .    . . . .   .              12a 
b    Enter  one-half  of  the  Additional  Medicare  Tax  you  paid  on  self-employment 
     income (Form 8959, line 13) . .    .  .   . .    .  . .    . . .    . . . .   .              12b 
c    Add lines 12a and 12b.   . .  .    .  .   . .    .  . .    . . .    . . . .   .              12c 
13 a Enter the amount, if any, of withheld social security, Medicare, and Additional
     Medicare  taxes  from  Puerto  Rico  Form(s)  499R-2/W-2PR  (attach  copy  of 
     form(s)). If married filing jointly, include your spouse’s amounts with yours .              13a
b    Enter the amount, if any, of employee social security and Medicare tax on tips
     not reported to employer from Form 4137 and shown on the dotted line next 
     to Part I, line 6  . . . . .  .    .  .   . .    .  . .    . . .    . . . .   .              13b
c    Enter  the  amount,  if  any,  of  uncollected  employee  social  security  and 
     Medicare  tax  on  wages  from  Form  8919  shown  on  the  dotted  line  next  to 
     Part I, line 6  .  . . . . .  .    .  .   . .    .  . .    . . .    . . . .   .              13c
d    Enter  the  amount,  if  any,  of  uncollected  employee  social  security  tax  and 
     Medicare tax on tips and group-term life insurance (see instructions for Part I, 
     line 6) shown on the dotted line next to Part I, line 6  . . . .    . . . .   .              13d
e    Enter the amount, if any, of Additional Medicare Tax on Medicare wages (Form
     8959, line 7)  .   . . . . .  .    .  .   . .    .  . .    . . .    . . . .   .              13e
f    Add lines 13a through 13e  .  .    .  .   . .    .  . .    . . .    . . . .   .              13f
14   Add lines 12c and 13f. Enter the result  .  .    .  . .    . . .    . . . .   .              14 
15   Enter the amount, if any, of Additional Medicare Tax withheld (Form 8959, line
     22)  . .       . . . . . . .  .    .  .   . .    .  . .    . . .    . . . .   .              15 
16   Subtract line 15 from line 14. Enter the result  .  . .    . . .    . . . .   .              16 
17   Enter the amount, if any, from Part I, line 8  . .  . .    . . .    . . . .   .              17 
18   Is the amount on line 16 more than the amount on line 17?
        No. Stop. You can’t claim the credit.
        Yes. Subtract line 17 from line 16. Enter the result  .   . .    . . . .   . .            .  . . . . . . 18 
19   Additional child tax credit. Enter the smaller of line 11 or line 18 here and on Part I, line 9     . . . . 19 
                                                                                                                  Form 1040-SS (2023)