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Form 4563: Exclusion of Income for Bona Fide Residents of American Samoa
Internal Revenue Service Form 4563 is the Exclusion of Income for Bona Fide Residents of American Samoa. It lets qualifying residents exclude income from American Samoa on their Form 1040 or 1040‑SR. A $1,000 penalty applies for missing required information.
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IRS Form 4563 - Exclusion of Income for Bona Fide Residents of American Samoa
Internal Revenue Service Form 4563 is the Exclusion of Income for Bona Fide Residents of American Samoa. It lets qualifying residents exclude income from American Samoa on their Form 1040 or 1040‑SR. A $1,000 penalty applies for missing required information.
Risk Radar
Scan points- 1Claiming the exclusion for U.S. Government employee services can incur a $1,000 penalty.
- 2Claiming exclusion for services performed as a U.S. Government employee
- 3Omitting the residence start and end dates on Part I line 1
- 4Failing to indicate the type of living quarters in Part I line 2
- 5Not reporting days absent in the required columns (a)‑(d)
Plain English
Form 4563 lets people who lived in American Samoa all year leave certain American Samoa income out of their taxable income. They attach the completed form to their Form 1040 or 1040‑SR. Income that isn’t excluded must still be reported.
Submission Date
- Filing date: 2024-10-31 22:10:18
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when you are a bona fide resident of American Samoa for the entire tax year and have income from sources within American Samoa or effectively connected with a trade or business in American Samoa that you wish to exclude on Form 1040 or 1040‑SR.
- Do not use it when you received compensation as an employee of the U.S. Government or its agencies, or when you are not a bona fide resident for the whole year.
- Check Form 8898 instead when you need to address residency‑related penalties or reporting changes.
Form selector
Use this form or another form?
Need to report worldwide income that does not qualify for exclusion
All taxable income must appear on the tax return
✓ Confirm all non‑excluded income is listed on Form 1040
Filing with a check or money order attached
Payment changes the IRS mailing address for the return
✓ Verify whether a payment is included before selecting the address
Residency or address change requires penalty reporting
Penalty instructions refer to Form 8898 for details
✓ Ensure Form 8898 is completed if a residency change applies
Deadline or filing window
Not stated in the official source.
Checklist
What you need before filling it out
Date bona fide residence began and ended
Exact residence dates · Part I, line 1
Type of living quarters in American Samoa
Selected housing option · Part I, line 2
Family members living with you? (a/b)
Answers to questions a and b · Part I, lines 3a/3b
Income amounts on lines 7‑14
Amounts of income from American Samoa sources · Part II, lines 7‑14
Signature
Signed name on the form · Bottom of the form
Before you submit
- 1Enter the start and end dates of your bona fide residence in line 1.
- 2Select the correct type of living quarters in line 2.
- 3Answer whether family members lived with you in line 3a and provide details in 3b if applicable.
- 4Indicate if you maintained any home outside American Samoa in line 4a.
- 5Report all qualifying American Samoa income on lines 7 through 14.
- 6Add lines 7 through 14 to compute the exclusion amount on line 15.
- 7Sign the form in the designated signature area.
- 8Attach Form 4563 to your completed Form 1040 or 1040‑SR before mailing.
How to file this form
- 1Complete Part I with residence dates, housing type, and family information and retain the completed section as proof of eligibility.
- 2Calculate the exclusion amount on lines 7‑15 in Part II and keep the worksheet for your records.
- 3Attach the finished Form 4563 to your Form 1040 or 1040‑SR as required and verify the attachment before mailing.
- 4Mail the combined return to the IRS address that matches your payment method and obtain a mailing receipt as proof of filing.
- 5File a copy of the entire return for your personal records as evidence of compliance.
Known limitations
- 1Cannot exclude amounts paid for services performed as an employee of the U.S. Government or its agencies, including civilian and military employees
- 2Exclusion does not apply to income that is not from sources within American Samoa or not effectively connected with a trade or business in American Samoa
- 3Taxpayers who are not bona fide residents for the entire tax year do not qualify for the exclusion
- 4Deductions or credits that are definitely related to the excluded income cannot be claimed on Form 1040 or 1040‑SR
- 5Special rules may limit exclusion of gains from dispositions of certain investment property within the first 10‑year period after becoming a bona fide resident
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
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Fillable formOpen in Editor->Form 4563 is revised September 2024 and the PDF directs users to www.irs.gov/Form4563 for the latest information. No changes are described in the source.
What changed or needs a fresh check
- Edition date — confirm the revision reads September 2024
- Fee — Not stated in the official source
- Mailing address — confirm the correct IRS address based on whether a check or money order is enclosed
- Signature — confirm the form is signed before filing
Quick Facts
Downloads
After you file
- 1Retain a copy of Form 4563 and all supporting documentation
- 2Keep books or records relating to the form for as long as their contents may become material in tax administration
- 3Do not claim any deduction or credit that is definitely related to the excluded income on the tax return
- 4If an error is discovered, file an amended return using the appropriate amendment form
- 5Monitor IRS correspondence for acknowledgment of receipt and processing status
Sources
- SRCForm p.1 — you may not exclude amounts paid for services performed as an employee of the U.S. Government or any of its agencies
- SRCForm p.1 — qualification requires bona fide residence for the entire tax year and income from sources within American Samoa or effectively connected with a trade or business there
- SRCForm p.1 — you cannot take any deduction or credit on your tax return that is definitely related to the excluded income
- SRCForm p.2 — special rules may apply to bona fide residents who have gain from dispositions of certain investment property within the 10‑year period beginning when they became a resident
- SRCForm p.1 — if you are not enclosing a check or money order, file your tax return with the Department of the Treasury, IRS, Austin, TX 73301‑0215; if you include a check or money order, file with IRS, P.O. Box 1303, Charlotte, NC 28201‑1303
- SRCForm p.1 — 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
Common confusion points
Can I exclude my salary as a U.S. government employee?
The form specifically bars exclusion of compensation for services performed as a U.S. Government employee.
→ Verify that your employer is not a U.S. federal agency before claiming the exclusion.
Do I have to be a resident for the whole year?
Qualification requires bona fide residence for the entire tax year.
→ Confirm that the residence dates cover January 1 through December 31 of the tax year.
May I claim deductions related to the excluded income?
The instructions prohibit any deduction or credit that is definitely related to the excluded income.
→ Review the return to ensure no such deductions or credits are included.
Where do I mail my return if I include a check or money order?
Filing addresses differ based on whether a payment is attached.
→ Use IRS P.O. Box 1303, Charlotte, NC 28201‑1303 when a check or money order is enclosed.
Is gain from selling personal property eligible for exclusion?
Personal‑property gains are sourced to the seller’s residence; a bona fide resident of American Samoa generally sources the gain within the territory.
→ Confirm your residency status and that the property sale meets the source rules.
What special rules apply to investment property sold within ten years of residency?
Special rules may limit exclusion of gains from certain investment property acquired during the first ten‑year period of bona fide residency.
→ Consult Pub. 570, chapter 2, or the cited regulations for the specific limitations.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 1040 – must be amended if the exclusion was claimed incorrectly
Questions about IRS Form 4563
What is IRS Form 4563 used for?
Form 4563 lets people who lived in American Samoa all year leave certain American Samoa income out of their taxable income. They attach the completed form to their Form 1040 or 1040‑SR. Income that isn’t excluded must still be reported.
Who must file IRS Form 4563?
Bona fide residents of American Samoa for the entire tax year who have income from sources within American Samoa or effectively connected with a trade or business there must file Form 4563.
What information does IRS Form 4563 require?
Part I gathers general information such as residence dates, type of living quarters, family members, homes outside American Samoa, employer details, and days absent. Part II figures the exclusion by entering amounts on lines 7 through 15 for wages, interest, dividends, business income, etc.
Where do I file IRS Form 4563?
If no check or money order is included, file the return with the Department of the Treasury, Internal Revenue Service, Austin, TX 73301-0215 USA. If a check or money order is included, file with the Internal Revenue Service, P.O. Box 1303, Charlotte, NC 28201-1303 USA.
How do I complete IRS Form 4563?
Enter the start and end dates of bona fide residence in Part I line 1, select the type of living quarters in line 2, and answer family and home questions. Record any days absent using columns (a)‑(d). In Part II, list qualifying income on lines 7‑15 and total on line 15. Sign the form, attach it to Form 1040 or 1040‑SR, and mail to the appropriate address.
What happens if IRS Form 4563 is filed incorrectly?
Failing to provide required information can trigger a $1,000 penalty for each failure, and claiming the exclusion for disallowed income can disqualify related deductions or credits.
Can I exclude my salary as a U.S. government employee?
The form specifically bars exclusion of compensation for services performed as a U.S. Government employee. Verify that your employer is not a U.S. federal agency before claiming the exclusion.
Do I have to be a resident for the whole year?
Qualification requires bona fide residence for the entire tax year. Confirm that the residence dates cover January 1 through December 31 of the tax year.
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