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Form
8843
Department of the TreasuryInternal Revenue Service
Statement for Exempt Individuals and IndividualsWith a Medical
Condition
For the year January 1December 31, 2007, or other tax
yearbeginning , 2007, and ending , 20 .
OMB No. 1545-0074
Your first name and initial
Address in country of residence
Your U.S. taxpayer identification number, if any
General Information 1a
2 3a
13
5
6
Type of U.S. visa (for example, F, J, M, Q, etc.) and date you
entered the United States
Of what country were you a citizen during the tax year? What
country issued you a passport? Enter your passport number
During 2007, did you apply for, or take other affirmative steps
to apply for, lawful permanent residentstatus in the United States
or have an application pending to change your status to that of a
lawfulpermanent resident of the United States?
7
8
9
10
11
12
Enter the name, address, and telephone number of the director of
the academic or other specialized program you participatedin during
2007
Enter the type of U.S. visa (J or Q) you held during:
Were you present in the United States as a teacher, trainee, or
student for any part of 2 of the 6 priorcalendar years (2001
through 2006)?
If you checked the Yes box on line 8, you cannot exclude days of
presence as a teacher or traineeunless you meet the Exception
explained on page 3.
Enter the name, address, and telephone number of the academic
institution you attended during 2007
No
Yes
Cat. No. 17227H
Form 8843 (2007)
Part III
Part I
Part II
Teachers and Trainees
No
Yes
Students
Enter the name, address, and telephone number of the director of
the academic or other specialized program you participatedin during
2007
Were you present in the United States as a teacher, trainee, or
student for any part of more than 5 calendaryears?
If you checked the Yes box on line 12, you must provide
sufficient facts on an attached statement toestablish that you do
not intend to reside permanently in the United States.
Enter the name, address, and telephone number of the academic
institution you attended during 2007
No
Yes
If you checked the Yes box on line 13, explain
14
For use by alien individuals only. Attachment
Sequence No. 102
2003
2004
2005
2006
2001
2002
For Paperwork Reduction Act Notice, see page 4.
Last name
Address in the United States Fill in your
addresses only if
you are filing thisform by itself andnot with your taxreturn
b
Current nonimmigrant status and date of change (see
instructions)
b 4a
b
Enter the actual number of days you were present in the United
States during: Enter the number of days in 2007 you claim you can
exclude for purposes of the substantial presence test
2007
2006
2005
. 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.
Enter the type of U.S. visa (F, J, M, or Q) you held during:
2003
2004
2005
2006
2001
2002
. 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.
20 07
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Form 8843 (2007)
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Individuals With a Medical Condition or Medical Problem
b
c
18
Describe the medical condition or medical problem that prevented
you from leaving the United States
Enter the date you intended to leave the United States prior to
the onset of the medical condition or medical problem describedon
line 17a
Enter the date you actually left the United States
Physicians 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 problemdescribed on
line 17a and there was no indication that his or her condition or
problem was preexisting.
Name of physician or other medical official
Physicians or other medical officials address and telephone
number
Professional Athletes 15
16
Enter the name of the charitable sports event(s) in the United
States in which you competed during 2007 and the dates
ofcompetition
Enter the name(s) and employer identification number(s) of the
charitable organization(s) that benefited from the
sportsevent(s)
Note. You must attach a statement to verify that all of the net
proceeds of the sports event(s) were contributed to the
charitableorganization(s) listed on line 16. Part V
Part IV
Sign hereonly if youare filingthis form byitself andnot with
your taxreturn
Under penalties of perjury, I declare that I have examined this
form and the accompanying attachments, and to the best of my
knowledge andbelief, they are true, correct, and complete.
Your signature
Date
17a
Physicians or other medical officials signature
Date
Form 8843 (2007)
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Form 8843 (2007)
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General Instructions Section references are to the
InternalRevenue Code unless otherwisespecified.
Who Must File If you are an alien individual, you must fileForm
8843 to explain the basis of yourclaim that you can exclude days
ofpresence in the United States forpurposes of the substantial
presence testbecause you: Were an exempt individual (other than
aforeign government-related individual) or
Substantial Presence Test You are considered a U.S. resident if
youmeet the substantial presence test for2007. You meet this test
if you werephysically present in the United States forat least: 31
days during 2007 and
Days of presence in the United States.Generally, you are treated
as beingpresent in the United States on any daythat you are
physically present in thecountry at any time during the
day.However, you do not count the followingdays of presence in the
United States forpurposes of the substantial presence test. 1. Days
you regularly commuted towork in the United States from aresidence
in Canada or Mexico. 2. Days you were in the United Statesfor less
than 24 hours when you weretraveling between two places outside
theUnited States.
4. Days you were unable to leave theUnited States because of a
medicalcondition or medical problem that arosewhile you were in the
United States.
5. Days you were an exemptindividual. Exempt Individuals For
purposes of the substantial presencetest, an exempt individual
includesanyone in the following categories. A teacher or trainee
(defined on thispage). A student (defined on this page).
A professional athlete temporarilypresent in the United States
to competein a charitable sports event.
Part IITeachers andTrainees
If you were a teacher or trainee undera J or Q visa, you are
considered tohave substantially complied with the visarequirements
if you have not engaged inactivities that are prohibited by
U.S.immigration laws and could result in the
loss of your J or Q visa status. Even if you meet these
requirements,you cannot exclude days of presence in2007 as a
teacher or trainee if you wereexempt as a teacher, trainee, or
studentfor any part of 2 of the 6 prior calendaryears. But see the
Exception below.
Were unable to leave the United Statesbecause of a medical
condition ormedical problem.
183 days during the period 2007, 2006,and 2005, counting all the
days ofphysical presence in 2007 but only 1/3the number of days of
presence in 2006and only 1/6 the number of days in 2005.
2. A foreign employer paid all yourcompensation during 2007.
3. You were present in the UnitedStates as a teacher or trainee
in any ofthe 6 prior years. 4. A foreign employer paid all of
yourcompensation during each of those prior6 years you were present
in the UnitedStates as a teacher or trainee. For more details, see
Pub. 519, U.S.
Tax Guide for Aliens.
Note. To claim the closer connection to aforeign country(ies)
exception to thesubstantial presence test described inRegulations
section 301.7701(b)-2, youmust file Form 8840, Closer
ConnectionException Statement for Aliens.
An individual temporarily present inthe United States as a
foreigngovernment-related individual.
1. You were exempt as a teacher,trainee, or student for any part
of 3 (orfewer) of the 6 prior calendar years.
Alien individuals with Q visas aretreated as students, teachers,
or traineesand, as such, are exempt individuals forpurposes of the
substantial presence testif they otherwise qualify. Q visas
areissued to aliens participating in certain
international cultural exchange programs.
A teacher or trainee is an individual whois temporarily present
in the United Statesunder a J or Q visa (other than as astudent)
and who substantially complieswith the requirements of the
visa.
Note. You can download forms andpublications from the IRS
website atwww.irs.gov .
If you qualify to exclude days of
presence as a student, complete Parts Iand III of Form 8843. If
you have a Qvisa, complete Part I and only lines 10through 14 of
Part III. On line 10, enterthe name, address, and telephonenumber
of the director of the culturalexchange program in which
youparticipated.
Part IIIStudents
If you were a student under an F,J, M, or Q visa, you are
consideredto have substantially complied with thevisa requirements
if you have notengaged in activities that are prohibitedby U.S.
immigration laws and couldresult in the loss of your visa
status.
1. Whether you have maintained acloser connection to a foreign
countrythan to the United States (for details,see Pub. 519) and 2.
Whether you have taken affirmativesteps to change your status
fromnonimmigrant to lawful permanentresident.
If you meet this exception, you mustattach information to verify
that a foreignemployer paid all the compensation youreceived in
2007 and all prior years thatyou were present in the United States
asa teacher or trainee.
Even if you meet these requirements,you cannot exclude days of
presence in2007 as a student if you were exempt asa teacher,
trainee, or student for anypart of more than 5 calendar yearsunless
you establish that you do notintend to reside permanently in
theUnited States. The facts and
circumstances to be considered indetermining if you have
demonstrated anintent to reside permanently in theUnited States
include, but are not limitedto:
A student is an individual who istemporarily present in the
United Statesunder an F, J, M, or Q visa andwho substantially
complies with therequirements of the visa.
3. Days you were temporarily in theUnited States as a regular
crew member ofa foreign vessel engaged in transportationbetween the
United States and a foreigncountry or a possession of the
UnitedStates unless you otherwise engaged intrade or business on
such a day.
If you qualify to exclude days ofpresence as a teacher or
trainee,complete Parts I and II of Form 8843. Ifyou have a Q visa,
complete Part I andonly lines 6 through 8 of Part II. On line6,
enter the name, address, andtelephone number of the director of
the
cultural exchange program in which youparticipated. Exception.
If you were exempt as ateacher, trainee, or student for any part
of2 of the 6 prior calendar years, you canexclude days of presence
in 2007 as ateacher or trainee only if all four of thefollowing
apply.
