Statement for Claiming Exemption From Withholding 
Form  673                         on Foreign Earned Income Eligible for the Exclusion(s)                              OMB No. 1545-0074 
(Rev. August 2019)                                       Provided by Section 911
Department of the Treasury                 ▶ Go to www.irs.gov/Form673 for the latest information.
Internal Revenue Service 
The following statement, when completed and furnished by a citizen of the United States to his or her employer, permits the employer 
to exclude from income tax withholding all or a part of the wages paid for services performed outside the United States. 
Your first name and initial                                Last name                                           Your social security number 

Part I         Qualification Information for Foreign Earned Income Exclusion 
I expect to qualify for the foreign earned income exclusion under either the bona fide residence or physical presence test for 
calendar year                     or other tax year beginning                              and ending                        . 
Please check applicable box: 
Bona Fide Residence Test 
I am a citizen of the United States. I have been a bona fide resident of and my tax home has been located in 
                                                                                (foreign country or countries) for an uninterrupted 
period which includes an entire tax year that began on                                              , 20         . 
                                                                                (date) 
I expect to remain a bona fide resident and retain my tax home in a foreign country (or countries) until the end of the tax year for 
which this statement is made. Or, if not that period, from the date of this statement until 
                                                                       , 20            . 
                              (date within tax year) 
      I have not submitted a statement to the authorities of any foreign country named above that I am not a resident of that country. 
Or, if I made such a statement, the authorities of that country thereafter made a determination to the effect that I am a resident of 
that country. 
      Based on the facts in my case, I have good reason to believe that for this period of foreign residence I will satisfy the tax home 
and the bona fide foreign resident requirements prescribed by section 911(d)(1)(A) of the Internal Revenue Code and qualify for the 
exclusion Code section 911(a) allows. 
Physical Presence Test 
I am a citizen of the United States. Except for occasional absences that will not disqualify me for the benefit of section   
911(a) of the Internal Revenue Code, I expect to be present in and maintain my tax home in 
                                                                                    (foreign country or countries) for a 12-month 
period that includes the entire tax year                         . Or, if not the entire year, for the part of the tax year beginning 
on                                , 20                 , and ending on                     , 20              . 

      Based on the facts in my case, I have good reason to believe that for this period of presence in a foreign country or  
countries, I will satisfy the tax home and the 330 full-day requirements within a 12-month period under section 911(d)(1)(B). 
Part II        Estimated Housing Cost Amount for Foreign Housing Exclusion (see instructions) 
1     Rent     .   .        . . . . .  . . .         . . . . . . .     .    . . . .    . . . .    . .    . . . .    1 
2     Utilities (other than telephone charges)  .        . . . . .     .    . . . .    . . . .    . .    . . . .    2 
3     Real and personal property insurance             . . . . . .     .    . . . .    . . . .    . .    . . . .    3 
4     Occupancy tax not deductible under section 164 .         . .     .    . . . .    . . . .    . .    . . . .    4 
5     Nonrefundable fees paid for securing a leasehold         . .     .    . . . .    . . . .    . .    . . . .    5 
6     Household repairs  .        . .  . . .         . . . . . . .     .    . . . .    . . . .    . .    . . . .    6 
7     Estimated qualified housing expenses. Add lines 1 through 6  .            . .    . . . .    . .    . . . .    7 
8     Estimated base housing amount for qualifying period  .           .    . . . .    . . . .    . .    . . . .    8 
9     Subtract line 8 from line 7. This is your estimated housing cost amount          . . . .    . .    . . . .    9 
Part III       Certification 
      Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and 
belief it is true, correct, and complete. I further certify under penalties of perjury that: 
• The estimated housing cost amount entered in Part II, plus the amount reported on any other statements outstanding with other 
employers, is not more than my total estimated housing cost amount. 
• If I become disqualified for the exclusions, I will immediately notify my employer and advise what part, if any, of the period for 
which I am qualified. 
      I understand that any exemption from income tax withholding permitted by reason of furnishing this statement is not a 
determination by the Internal Revenue Service that any amount paid to me for any services performed during the tax year is 
excludable from gross income under the provisions of Code section 911(a). 
Your Signature                                                                                                 Date 

For Paperwork Reduction Act Notice, see instructions.                             Cat. No. 10183Y                   Form 673 (Rev. 8-2019) 

Form 673 (Rev. 8-2019)                                                                                                     Page  2 

Instructions                                                      Information for Employer 
                                                                  Once you have received Form 673 completed by the employee, 
Future Developments                                               you may discontinue withholding of U.S. income tax on those 
For the latest information about developments related to Form     wages that qualify for the exclusion(s). If for any reason you 
673 and its instructions, such as legislation enacted after they  believe the employee will not qualify for the exclusion(s), you 
were published, go to wwwirs.gov/Form673..                        should disregard Form 673. 
                                                                  Note: If you have questions about the exclusion(s), see 
What’s New                                                        Pub. 54. 
Service performed in a combat zone. For tax years beginning 
after December 31, 2017, new rules regarding the tax home test    Paperwork Reduction Act Notice 
apply for certain individuals serving in a combat zone in support 
of the U.S. Armed Forces. For more information, see the           We ask for the information on this form to carry out the Internal 
Instructions for Form 2555.                                       Revenue laws of the United States. If you want to claim an 
                                                                  exemption from withholding, you’re required to give this form (or 
Form 2555-EZ. After tax year 2018, the Form 2555-EZ won’t be      similar statement) to your employer. 
available to make the election to exclude foreign earned income 
and the foreign housing cost amount. Beginning with tax year      You aren’t required to provide the information requested on a 
2019, all taxpayers will be required to use the Form 2555 to      form that is subject to the Paperwork Reduction Act unless the 
claim the foreign earned income exclusion.                        form displays a valid OMB control number. Books or records 
                                                                  relating to a form or its instructions must be retained as long as 
Information for Employee                                          their contents may become material in the administration of any 
Give Form 673 to your U.S. employer to claim an exemption         Internal Revenue law. Generally, tax  returns and return 
from U.S. income tax withholding on wages earned abroad to        information are confidential, as required by Code section 6103. 
the extent of the foreign earned income exclusion and foreign     The average time and expenses required to complete and file 
housing exclusion. Your employer will then withhold the correct   this form will vary depending on individual circumstances. For 
amount of federal income tax from your pay.                       the estimated averages, see the instructions for your income tax 
If you qualify for the foreign earned income exclusion or the     return. 
foreign housing exclusion or deduction, complete Form 2555.       If you have suggestions for making this form simpler, we  
You must attach the completed Form 2555 to your Form 1040         would be happy to hear from you. See the instructions for your 
or Form 1040-SR to claim your exclusion or deduction.             income tax return. 
Estimated housing cost amount. The amount of qualified  
housing expenses eligible for the housing exclusion is limited  
depending on the location of your foreign tax home. See Pub. 
54 and the Instructions for Form 2555 for more details.