Form 8840
Form 8840
Department of the Treasury
Internal Revenue Service
Closer Connection Exception Statement for Aliens
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Attach to Form 1040NR or Form 1040NR-EZ.
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Information about Form 8840 and its instructions is at www.irs.gov/form8840.
For the year January 1—December 31, 2016, or other tax year
beginning
, 2016, and ending
, 20 .
OMB No. 1545-0074
2016
Attachment
Sequence No.
101
Your first name and initial Last name Your U.S. taxpayer identification number, 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 residence Address in the United States
Part I General Information
1
Type of U.S. visa (for example, F, J, M, etc.) and date you entered the United States
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2 Of what country or countries were you a citizen during the tax year?
3
What country or countries issued you a passport?
4
Enter your passport number(s)
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5 Enter the number of days you were present in the United States during:
2016 2015 2014 .
6
During 2016, 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? See instructions . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
Part II Closer Connection to One Foreign Country (see instructions)
7 Where was your tax home during 2016?
8 Enter the name of the foreign country to which you had a closer connection than to the United States during 2016.
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Next, complete Part IV.
Part III Closer Connection to Two Foreign Countries (see instructions)
9 Where was your tax home on January 1, 2016?
10 After changing your tax home from its location on January 1, 2016, where was your tax home for the remainder of 2016?
11
Did you have a closer connection to each foreign country listed on lines 9 and 10 than to the United States
for the period during which you maintained a tax home in that foreign country? . . . . . . . . . .
Yes No
If “No,” attach an explanation.
12
Were you subject to tax as a resident under the internal laws of (a) either of the countries listed on lines 9 and
10 during all of 2016 or (b) both of the countries listed on lines 9 and 10 for the period during which you
maintained a tax home in each country? . . . . . . . . . . . . . . . . . . . . . .
Yes No
13 Have you filed or will you file tax returns for 2016 in the countries listed on lines 9 and 10? . . . . . .
Yes No
If “Yes” to either line 12 or line 13, attach verification.
If “No” to either line 12 or line 13, please explain
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Next, complete Part IV.
For Paperwork Reduction Act Notice, see page 4.
Cat. No. 15829P
Form 8840 (2016)
Form 8840 (2016)
Page 2
Part IV Significant Contacts With Foreign Country or Countries in 2016
14 Where was your regular or principal permanent home located during 2016? See instructions.
15
If you had more than one permanent home available to you at all times during 2016, list the location of each and
explain
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16 Where was your family located?
17
Where was your automobile(s) located?
18
Where was your automobile(s) registered?
19 Where were your personal belongings, furniture, etc., located?
20 Where was the bank(s) with which you conducted your routine personal banking activities located?
a
b
c
d
21 Did you conduct business activities in a location other than your tax home? . . . . . . . . . . . Yes No
If “Yes,” where?
22a
Where was your driver’s license issued?
b
If you hold a second driver’s license, where was it issued?
23 Where were you registered to vote?
24
When completing official documents, forms, etc., what country do you list as your residence?
25 Have you ever completed:
a Form W-8BEN or any other W-8 form (relating to foreign status)? . . . . . . . . . . . . . .
Yes No
b Form W-9, Request for Taxpayer Identification Number and Certification? . . . . . . . . . . .
Yes No
c Form 1078, Certificate of Alien Claiming Residence in the United States? . . . . . . . . . . . .
Yes No
d
Any other U.S. official forms? If “Yes,” indicate the form(s)
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Yes No
26
In what country or countries did you keep your personal, financial, and legal documents?
27 From what country or countries did you derive the majority of your 2016 income?
28 Did you have any income from U.S. sources? . . . . . . . . . . . . . . . . . . . . . Yes No
If “Yes,” what type?
29 In what country or countries were your investments located? See instructions.
30 Did you qualify for any type of “national” health plan sponsored by a foreign government? . . . . . . Yes No
If “Yes,” in what country?
If “No,” please explain
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If you have any other information to substantiate your closer connection to a country other than the United States or you wish
to explain in more detail any of your responses to lines 14 through 30, attach a statement to this form.
Sign here
only if you
are filing
this form by
itself and
not with
your U.S.
tax return
Under penalties of perjury, I declare that I have examined this form and the accompanying attachments, and to the best of my knowledge and belief, they
are true, correct, and complete.
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Your signature
▲
Date
Form 8840 (2016)
Form 8840 (2016)
Page 3
Section references are to the U.S.
Internal Revenue Code, unless otherwise
specified.
Future Developments
For the latest information about
developments related to Form 8840 and
its instructions, such as legislation
enacted after they were published, go to
www.irs.gov/form8840.
General Instructions
Purpose of Form
Use Form 8840 to claim the closer
connection to a foreign country(ies)
exception to the substantial presence
test. The exception is described later
and in Regulations section
301.7701(b)-2.
Note: You are not eligible for the closer
connection exception if any of the
following apply.
• You were present in the United States
183 days or more in calendar year 2016.
• You are a lawful permanent resident of
the United States (that is, you are a
green card holder).
• You have applied for, or taken other
affirmative steps to apply for, a green
card; or have an application pending to
change your status to that of a lawful
permanent resident of the United States.
Even if you are not eligible for the
closer connection exception, you may
qualify for nonresident status by reason
of a treaty. See the instructions for line 6
for more details.
Who Must File
If you are an alien individual and you
meet the closer connection exception to
the substantial presence test, you must
file Form 8840 with the IRS to establish
your claim that you are a nonresident of
the United States by reason of that
exception. Each alien individual must file
a separate Form 8840 to claim the closer
connection exception.
For more details on the substantial
presence test and the closer connection
exception, see Pub. 519, U.S. Tax Guide
for Aliens.
Note: You can download forms and
publications at IRS.gov.
Substantial Presence Test
You are considered a U.S. resident if you
meet the substantial presence test for
2016. You meet this test if you were
physically present in the United States
for at least:
• 31 days during 2016 and
• 183 days during the period 2016, 2015,
and 2014, counting all the days of
physical presence in 2016 but only 1/3
the number of days of presence in 2015
and only 1/6 the number of days in 2014.
Days of presence in the United States.
Generally, you are treated as being
present in the United States on any day
that you are physically present in the
country at any time during the day.
However, you do not count the
following days of presence in the United
States for purposes of the substantial
presence test.
1. Days you regularly commuted to
work in the United States from a
residence in Canada or Mexico.
2. Days you were in the United States
for less than 24 hours when you were
traveling between two places outside the
United States.
3. Days you were temporarily in the
United States as a regular crew member
of a foreign vessel engaged in
transportation between the United
States and a foreign country or a
possession of the United States unless
you otherwise engaged in trade or
business on such a day.
4. Days you were unable to leave the
United States because of a medical
condition or medical problem that arose
while you were in the United States.
5. Days you were an exempt
individual.
In general, an exempt individual is a
(a) foreign government-related individual
(b) teacher or trainee, (c) student, or
(d) professional athlete competing in a
charitable sports event. For more details,
see Pub. 519.
Note: If you qualify to exclude days of
presence in the United States because
you were an exempt individual (other
than a foreign government-related
individual) or because of a medical
condition or medical problem (see item 4
above), you must file Form 8843,
Statement for Exempt Individuals and
Individuals With a Medical Condition.
Closer Connection Exception
Even though you would otherwise meet
the substantial presence test, you will
not be treated as a U.S. resident for
2016 if:
• You were present in the United States
for fewer than 183 days during 2016,
• You establish that during 2016, you
had a tax home in a foreign country, and
• You establish that during 2016, you
had a closer connection to one foreign
country in which you had a tax home
than to the United States, unless you
had a closer connection to two foreign
countries.
Closer Connection to Two Foreign
Countries
You can demonstrate that you have a
closer connection to two foreign
countries (but not more than two) if all
five of the following apply.
1. You maintained a tax home as of
January 1, 2016, in one foreign country.
2. You changed your tax home during
2016 to a second foreign country.
3. You continued to maintain your tax
home in the second foreign country for
the rest of 2016.
4. You had a closer connection to
each foreign country than to the United
States for the period during which you
maintained a tax home in that foreign
country.
5. You are subject to tax as a resident
under the tax laws of either foreign
country for all of 2016 or subject to tax
as a resident in both foreign countries for
the period during which you maintained
a tax home in each foreign country.
Tax Home
Your tax home is your main place of
business, employment, or post of duty
regardless of where you maintain your
family home. If you do not have a regular
or main place of business because of the
nature of your work, then your tax home
is the place where you regularly live. If
you do not fit either of these categories,
you are considered an itinerant and your
tax home is wherever you work.
Establishing a Closer Connection
You will be considered to have a closer
connection to a foreign country than to
the United States if you or the IRS
establishes that you have maintained
more significant contacts with the
foreign country than with the United
States.
Your answers to the questions in Part
IV will help establish the jurisdiction to
which you have a closer connection.
When and Where To File
If you are filing a 2016 Form 1040NR or
Form 1040NR-EZ, attach Form 8840 to
it. Mail your tax return by the due date
(including extensions) to the address
shown in your tax return instructions.
If you do not have to file a 2016 tax
return, mail Form 8840 to the
Department of the Treasury, Internal
Revenue Service Center, Austin, TX
73301-0215 by the due date (including
extensions) for filing Form 1040NR or
Form 1040NR-EZ.
Form 8840 (2016)
Page 4
Penalty for Not Filing Form
8840
If you do not timely file Form 8840, you
will not be eligible to claim the closer
connection exception and may be
treated as a U.S. resident.
You will not be penalized if you can
show by clear and convincing evidence
that you took reasonable actions to
become aware of the filing requirements
and significant steps to comply with
those requirements.
Specific Instructions
Part I
Line 1
If you had a visa on the last day of the
tax year, enter your visa type and the
date you entered the United States. If
you do not have a visa, enter your U.S.
immigration status on the last day of the
tax year and the date you entered the
United States. For example, if you
entered under the visa waiver program,
enter “VWP”, the name of the Visa
Waiver Program country and the date
you entered the United States.
Line 6
If you checked the “Yes” box on line 6,
do not file Form 8840. You are not
eligible for the closer connection
exception. However, you may qualify for
nonresident status by reason of a treaty.
See Pub. 519 for details. If so, file Form
8833, Treaty-Based Return Position
Disclosure Under Section 6114 or
7701(b), with your Form 1040NR or Form
1040NR-EZ.
Parts II and III
Complete Part II or Part III (but not both)
depending on the number of countries to
which you are claiming a closer
connection. If you are claiming a closer
connection to one country, complete
Part II. If you are claiming a closer
connection to two or more countries,
complete Part III. After completing Part
II or Part III, complete Part IV.
Part IV
Line 14
A “permanent home” is a dwelling unit
(whether owned or rented, and whether
a house, an apartment, or a furnished
room) that is available at all times,
continuously and not solely for short
stays.
Line 29
For stocks and bonds, indicate the
country of origin of the stock company
or debtor. For example, if you own
shares of a U.S. publicly traded
corporation, the investment is
considered located in the United States,
even though the shares of stock are
stored in a safe deposit box in a foreign
country.
Paperwork Reduction Act Notice. We
ask for the information on this form to
carry out the Internal Revenue laws of
the United States. Section 7701(b) and
its regulations require that you give us
the information. We need it to determine
if you meet the closer connection
exception to the substantial presence
test.
You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act
unless the form displays a valid OMB
control number. Books or records
relating to a form or its instructions must
be retained as long as their contents
may become material in the
administration of any Internal Revenue
law. Generally, tax returns and return
information are confidential, as required
by section 6103.
The average time and expenses
required to complete and file this form
will vary depending on individual
circumstances. For the estimated
averages, see the instructions for your
income tax return.
If you have suggestions for making
this form simpler, we would be happy to
hear from you. See the instructions for
your income tax return.
