OMB No. 1545-0074
SCHEDULE OI                                              Other Information
(Form 1040-NR)                    ▶ Go to www.irs.gov/Form1040NR for instructions and the latest information. 
Department of the Treasury                               ▶ Attach to Form 1040-NR.                                          2021
                                                                                                                            Attachment   
Internal Revenue Service (99)                              ▶ Answer all questions.                                          Sequence No. 7C
Name shown on Form 1040-NR                                                                                    Your identifying number

A    Of what country or countries were you a citizen or national during the tax year?
B    In what country did you claim residence for tax purposes during the tax year?
C    Have you ever applied to be a green card holder (lawful permanent resident) of the United States?  .     .     . .   .   Yes         No
D    Were you ever:
  1. A U.S. citizen?          . . .   . . .   . .    . . . .  .  .     . . . .  .      . . . . .     .    . . .     . .   .   Yes         No
  2. A green card holder (lawful permanent resident) of the United States?  .   .      . . . . .     .    . . .     . .   .   Yes         No
     If you answer “Yes” to (1) or (2), see Pub. 519, chapter 4, for expatriation rules that apply to you.
E    If you had a visa on the last day of the tax year, enter your visa type. If you did not have a visa, enter your U.S. 
     immigration status on the last day of the tax year.
F    Have you ever changed your visa type (nonimmigrant status) or U.S. immigration status?  .       .    . . .     . .   .   Yes         No
     If you answered “Yes,” indicate the date and nature of the change ▶
G    List all dates you entered and left the United States during 2021. See instructions.
     Note: If you are a resident of Canada or Mexico     AND commute to work in the United States at frequent intervals, 
     check the box for Canada or Mexico and skip to item H  .          . . . .  .      . . .   Canada               Mexico
     Date entered United States           Date departed United States              Date entered United States       Date departed United States  
                mm/dd/yy                        mm/dd/yy                                   mm/dd/yy                         mm/dd/yy

H    Give number of days (including vacation, nonworkdays, and partial days) you were present in the United States during:
     2019                                     , 2020                         , and 2021                               .
I    Did you file a U.S. income tax return for any prior year? . .     . . . .  .      . . . . .     .    . . .     . .   .   Yes         No
     If “Yes,” give the latest year and form number you filed ▶
J    Are you filing a return for a trust? .   . .    . . . .  .  .     . . . .  .      . . . . .     .    . . .     . .   .   Yes         No
     If “Yes,” did the trust have a U.S. or foreign owner under the grantor trust rules, make a distribution or loan to a 
     U.S. person, or receive a contribution from a U.S. person? .      . . . .  .      . . . . .     .    . . .     . .   .   Yes         No
K    Did you receive total compensation of $250,000 or more during the tax year? .       . . . .     .    . . .     . .   .   Yes         No
     If “Yes,” did you use an alternative method to determine the source of this compensation?       .    . . .     . .   .   Yes         No
L    Income Exempt From Tax—If you are claiming exemption from income tax under a U.S. income tax treaty with a foreign country, 
     complete (1) through (3) below. See Pub. 901 for more information on tax treaties.
  1. Enter the name of the country, the applicable tax treaty article, the number of months in prior years you claimed the treaty benefit, and the 
     amount of exempt income in the columns below. Attach Form 8833 if required. See instructions.
                                  (a) Country                    (b) Tax treaty article  (c) Number of months         (d) Amount of exempt         
                                                                                         claimed in prior tax years income in current tax year

     (e)  Total. Enter this amount on Form 1040-NR, line 1c. Do not enter it on line 1a or line 1b   .    . . ▶
  2. Were you subject to tax in a foreign country on any of the income shown in 1(d) above?    .     .    . . .     . .   .   Yes         No
  3. Are you claiming treaty benefits pursuant to a Competent Authority determination?  .    . .     .    . . .     . .   .   Yes         No
     If “Yes,” attach a copy of the Competent Authority determination letter to your return.
M    Check the applicable box if:
  1. This is the first year you are making an election to treat income from real property located in the United States as effectively connected 
     with a U.S. trade or business under section 871(d). See instructions  . .  .      . . . . .     .    . . .     . .   . . .  .   .   ▶
  2. You have made an election in a previous year that has not been revoked, to treat income from real property located in the United 
     States as effectively connected with a U.S. trade or business under section 871(d). See instructions .   .     . .   . . .  .   .   ▶
For Paperwork Reduction Act Notice, see the Instructions for Form 1040-NR.               Cat. No. 72756T            Schedule OI (Form 1040-NR) 2021