4563

Exclusion of Income for Bona Fide Residents of American Samoa

Agency
IRS
Revision
Rev. September 2024
Fillable fields
45
Pages
2
Official source
IRS form page
Checked
October 21, 2026
Fill 4563 online
Page 1 of form 4563

Form 4563: Exclusion of Income for Bona Fide Residents of American Samoa

Form 4563 is used to figure the amount of income from American Samoa that may be excluded from gross income on Form 1040 or 1040-SR. It is attached to that return.

The form says a person generally qualifies for the exclusion if they were a bona fide resident of American Samoa for the entire tax year and the income was from sources within American Samoa or effectively connected with the conduct of a trade or business there. It also says amounts paid for services as an employee of the U.S. Government or its agencies, civilian or military, may not be excluded.

Part I asks about your residence, home and days away, and Part II adds up the qualifying income. The instructions are printed on the form itself. You can fill out the form free in your browser on this page and download the result without an account.

Top of page 1 of Form 4563: Exclusion of Income for Bona Fide Residents of American Samoa, as printed by IRS

What's on Form 4563

Header

The name or names shown on Form 1040 or 1040-SR and your social security number.

Part I, lines 1 to 3

The dates bona fide residence began and ended, the type of living quarters in American Samoa, and whether family lived with you.

Part I, lines 4 and 5

Whether you kept any home outside American Samoa, with its address and occupants, and the name and address of your employer or a note that you are self-employed.

Part I, line 6

A table of days absent from American Samoa during the tax year: date left, date returned, number of days absent and reason.

Part II, lines 7 to 15

Qualifying wages, interest, dividends, business income, capital gain, rental and royalty income, farm income and other income, totaled on line 15.

How to fill out Form 4563

  1. 1

    Header

    Enter the name or names as shown on Form 1040 or 1040-SR and your social security number.

  2. 2

    Part I

    Enter the residence dates, check the type of living quarters, answer the family and outside home questions, and enter your employer's name and address.

    Part I on page 1 of Form 4563: Exclusion of Income for Bona Fide Residents of American Samoa, as printed by IRS
  3. 3

    Line 6

    List each absence from American Samoa during the tax year with the dates, the number of days and the reason.

  4. 4

    Lines 7 to 14

    The form says to include only income from sources within American Samoa or effectively connected with a trade or business there. For wages, it says to include only pay earned while in American Samoa.

  5. 5

    Line 15

    Add lines 7 through 14. The form says this is the amount that may be excluded from gross income for the tax year.

  6. 6

    Attach it

    Attach Form 4563 to Form 1040 or 1040-SR. The form says deductions and credits definitely related to the excluded income cannot be taken on the return.

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Where to file and what else to know

Without a payment

The form says to file the return, including Form 4563, with the Department of the Treasury, Internal Revenue Service, Austin, TX 73301-0215 USA.

With a check or money order

The form says to file the return with the Internal Revenue Service, P.O. Box 1303, Charlotte, NC 28201-1303 USA.

Other income

The form says worldwide income that does not qualify for the exclusion is still reported on the tax return, whatever its source.

Shared deductions

The form says deductions not definitely related to one type of income, such as the standard deduction, are allocated between excluded and other income. Chapter 4 of Pub. 570 explains how.

Form 8898 penalty

The form says failing to provide information required on Form 8898 may bring a $1,000 penalty for each failure unless due to reasonable cause and not willful neglect.

Related forms

Who fills out Form 4563?

  • Bona fide residents of American Samoa

    The form says it is for people who were bona fide residents of American Samoa for the entire tax year and have income from sources there or from a trade or business there.

  • Self-employed residents

    The form says net earnings from self-employment of $400 or more generally owe self-employment tax even if excluded from gross income, figured on Schedule SE (Form 1040).

  • Not for U.S. Government pay

    The form says amounts paid for services as a civilian or military employee of the U.S. Government cannot be excluded. This does not include employees of the American Samoa government.

  • People who moved in or out

    The form says a person who became or ceased to be a bona fide resident of a U.S. territory may be required to file Form 8898.

The form is completed by an individual and attached to their own Form 1040 or 1040-SR. Pub. 570 has the general and special rules the form refers to.

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Questions about Form 4563

What does Form 4563 attach to?

The form says to attach it to Form 1040 or 1040-SR.

Who does the form say qualifies?

The form says a person generally qualifies if they were a bona fide resident of American Samoa for the entire tax year and the income was from sources there or effectively connected with a trade or business there.

Can U.S. Government pay be excluded?

The form says amounts paid for services as an employee of the U.S. Government or its agencies, civilian or military, may not be excluded. Employees of the American Samoa government are not covered by that rule.

Is self-employment tax still due on excluded earnings?

The form says net earnings from self-employment of $400 or more generally owe self-employment tax even when excluded, figured on Schedule SE (Form 1040).

Where is the return with Form 4563 mailed?

The form lists Austin, TX 73301-0215 USA without a payment, and P.O. Box 1303, Charlotte, NC 28201-1303 USA with a check or money order.

Where are the detailed rules?

The form points to Pub. 570, Tax Guide for Individuals With Income From U.S. Possessions, for the general and special rules for completing Form 4563.