Statement for Exempt Individuals and Individuals with a Medical Condition

• Legal Form Number: 8843
• Year: 2025
• Issuer: Treasury Department
• Section: Treasury Department

Form 8843

Department of the Treasury

Internal Revenue Service

Statement for Exempt Individuals and Individuals

With a Medical Condition

For use by alien individuals only.

Go to www.irs.gov/Form8843 for the latest information.

For the year January 1—December 31, 2023, or other tax year

beginning, 2023, and ending, 20.

OMB No. 1545-0074

2023

Attachment

Sequence No. 102

Your first name and initial Last nameYour U.S. taxpayer identification number (TIN), if any

Fill in your

addresses only if

you are filing this

form by itself and

not with your U.S.

tax return.

Address in country of residenceAddress in the United States

Part IGeneral Information

1a Type of U.S. visa (for example, F, J, M, Q, etc.) and date you entered the United States:

bCurrent nonimmigrant status. If your status has changed, also enter date of change and previous status. See instructions.

2Of what country or countries were you a citizen during the tax year?

3aWhat country or countries issued you a passport?

bEnter your passport number(s):

4a Enter the actual number of days you were present in the United States during:

2023 2022 2021

bEnter the number of days in 2023 you claim you can exclude for purposes of the substantial presence test:

Part IITeachers and Trainees

5For teachers, enter the name, address, and telephone number of the academic institution where you taught in 2023:

6For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program you

participated in during 2023:

7Enter 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.

8Were you exempt as a teacher, trainee, or student for any part of 2 of the preceding 6 calendar years (2017

through2022)?...............................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 IIIStudents

9Enter 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. 17227HForm 8843 (2023)