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DO NOT FILE
July 30, 2021
DRAFT AS OF
Form 1040-SS
2021
U.S. Self-Employment Tax Return
(Including the Refundable Child Tax Credit for Bona Fide Residents of Puerto Rico)
Department of the Treasury
Internal Revenue Service
U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, or Puerto Rico
OMB No. 1545-0090
For the year Jan. 1–Dec. 31, 2021, or other tax year beginning
, 2021, and ending , 20
Please type or print.
Your first name and initial Last name Your social security number
If a joint return, spouse’s first name and initial Last name Spouse’s social security number
Present home address (number, street, and apt. no., or rural route)
City, town or post office, commonwealth or territory, and ZIP code
Foreign country name Foreign province/state/county Foreign postal code
At any time during 2021, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency?
Yes No
Part I Total Tax and Credits
1 Filing status. Check the box for your filing status. See instructions.
Single
Married filing jointly
Married filing separately (MFS) Head of household Qualifying Widow(er)
If you checked the MFS box, enter spouse’s social security no. above and full name here
2 Qualifying children. Complete only if you are a bona fide resident of Puerto Rico and you are claiming the refundable child tax
credit. See instructions. If more than four qualifying children, see instructions and check here . . . . . . . . . .
(a) First name Last name (b) Child’s social security number (c) Child’s relationship to you
3 Self-employment tax from Part V, line 12 . . . . . . . . . . . . . . . . . . . . 3
4 Household employment taxes (see instructions). Attach Schedule H (Form 1040) . . . . . . . 4
5 a Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . . . . 5a
b Repayment of advance child tax credit (see instructions) . . . . . . . . . . . . . . . 5b
6 Total tax. Add lines 3 through 5b. See instructions . . . . . . . . . . . . . . . . . 6
7 2021 estimated tax payments (see instructions) . . . . . . . . . . 7
8 Excess social security tax withheld (see instructions) . . . . . . . . 8
9 Refundable child tax credit from Part II, line 3 . . . . . . . . . . . 9
10 Health coverage tax credit. Attach Form 8885 . . . . . . . . . . . 10
11a
Credit for qualified sick and family leave wages for leave taken before April 1, 2021
11a
b
Credit for qualified sick and family leave wages for leave taken after March 31, 2021
11b
12 Total payments and credits (see instructions) . . . . . . . . . . . . . . . . . . 12
13 If line 12 is more than line 6, subtract line 6 from line 12. This is the amount you overpaid . . . . 13
14a Amount of line 13 you want refunded to you. If Form 8888 is attached, check here . . . .
14a
b
Routing number
c Type: Checking Savings
d
Account number
15 Amount of line 13 you want applied to 2022 estimated tax . . . . .
15
16 Amount you owe. If line 6 is more than line 12, subtract line 12 from line 6. See instructions . .
16
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS? See instructions. Yes. Complete the following. No
Designee’s
name
Phone
no.
Personal Identification
Number (PIN)
Sign
Here
Joint return?
See instructions.
Keep a copy
for your records.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
and belief, they are true, correct, and complete. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has
any knowledge.
Your signature Date
Daytime phone number
If the IRS sent you an Identity Protection PIN,
enter it here
(see instructions)
Spouse’s signature. If a joint return, both must sign. Date
If the IRS sent your spouse an Identity Protection
PIN, enter it here
(see instructions)
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
Firm’s address
Firm’s EIN
Phone no.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice,
see instructions.
www.irs.gov/Form1040SS Cat. No. 17184B
Form 1040-SS (2021)
DO NOT FILE
July 30, 2021
DRAFT AS OF
Form 1040-SS (2021)
Page 2
Part II Bona Fide Residents of Puerto Rico Claiming Refundable Child Tax Credit—See instructions.
Tip: Bona fide residents of Puerto Rico may claim the refundable child tax credit for one or more qualifying children.
1 Modified adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . 1
2 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3
Refundable child tax credit. Use the Refundable Child Tax Credit Worksheet in the instructions. Enter
the amount from line 20 of the worksheet here and on Part I, line 9 . . . . . . . . . . . .
3
Part III Profit or Loss From Farming—See the Instructions for Schedule F (Form 1040).
Name of proprietor Social security number
Note: If you are filing a joint return and both you and your spouse had a profit or loss from a farming business, see Joint returns and
Business Owned and Operated by Spouses in the instructions for more information.
Section A—Farm Income—Cash Method
Complete Sections A and B. (Accrual method taxpayers, complete Sections B and C, and Section A, line 11.)
Don’t include sales of livestock held for draft, breeding, sport, or dairy purposes. See instructions.
1 Sales of livestock and other items you bought for resale . . . . . . . 1
2 Cost or other basis of livestock and other items reported on line 1 . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Sales of livestock, produce, grains, and other products you raised . . . . . . . . . . . . 4
5a Total cooperative distributions (Form(s) 1099-PATR) 5a 5b Taxable amount 5b
6 Agricultural program payments received . . . . . . . . . . . . . . . . . . . . 6
7 Commodity Credit Corporation (CCC) loans reported under election (or forfeited) . . . . . . . 7
8 Crop insurance proceeds . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . . . 9
10 Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11
Gross farm income. Add amounts in the right column for lines 3 through 10. If accrual method
taxpayer, enter the amount from Section C, line 50 . . . . . . . . . . . . . . . .
11
Section B—Farm Expenses—Cash and Accrual Method
Don’t include personal or living expenses (such as taxes, insurance, or repairs on your home) that didn’t produce farm income.
Reduce the amount of your farm expenses by any reimbursements before entering the expenses below.
12 Car and truck expenses
(see instructions) . . . . . 12
13 Chemicals . . . . . . . 13
14 Conservation expenses . . . 14
15 Custom hire (machine work) . .
15
16
Depreciation and section 179
expense deduction not claimed
elsewhere (attach Form 4562 if
required) . . . . . . . .
16
17 Employee benefit programs other
than on line 25 . . . . . .
17
18 Feed purchased . . . . . . 18
19 Fertilizers and lime . . . . . 19
20 Freight and trucking . . . . 20
21 Gasoline, fuel, and oil . . . . 21
22 Insurance (other than health) . 22
23 Interest (see instructions):
a Mortgage (paid to banks, etc.) . 23a
b Other . . . . . . . . .
23b
24 Labor hired . . . . . . . 24
25 Pension and profit-sharing plans 25
26 Rent or lease:
a Vehicles, machinery, and
equipment . . . . . . . .
26a
b Other (land, animals, etc.) . . . 26b
27 Repairs and maintenance . . . 27
28 Seeds and plants purchased . . 28
29 Storage and warehousing . . 29
30 Supplies purchased . . . . 30
31 Taxes . . . . . . . . . 31
32 Utilities . . . . . . . . . 32
33
Veterinary, breeding, and medicine
33
34 Other expenses (specify):
a 34a
b 34b
c 34c
d 34d
e 34e
35 Total expenses. Add lines 12 through 34e . . . . . . . . . . . . . . . . . . .
35
36 Net farm profit or (loss). Subtract line 35 from line 11. Enter the result here and on Part V, line 1a .
36
Form 1040-SS (2021)
DO NOT FILE
July 30, 2021
DRAFT AS OF
Form 1040-SS (2021)
Page 3
Section C—Farm Income—Accrual Method
Don’t include sales of livestock held for draft, breeding, sport, or dairy purposes on any of the lines below. See instructions.
37 Sales of livestock, produce, grains, and other products during the year . . . . . . . . . . 37
38 a Total cooperative distributions (Form(s) 1099-PATR) 38a 38b Taxable amount 38b
39 Agricultural program payments received . . . . . . . . . . . . . . . . . . . . 39
40 Commodity Credit Corporation (CCC) loans reported under election (or forfeited) . . . . . . . 40
41 Crop insurance proceeds . . . . . . . . . . . . . . . . . . . . . . . . . 41
42 Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . . . 42
43
Other farm income (specify)
43
44 Add lines 37, 38b, and 39 through 43 . . . . . . . . . . . . . . . . . . . . . 44
45 Inventory of livestock, produce, grains, and other products at the beginning of
the year . . . . . . . . . . . . . . . . . . . . . . .
45
46
Cost of livestock, produce, grains, and other products purchased during the year
46
47 Add lines 45 and 46 . . . . . . . . . . . . . . . . . . . 47
48
Inventory of livestock, produce, grains, and other products at the end of the year
48
49 Cost of livestock, produce, grains, and other products sold. Subtract line 48 from line 47* . . . . 49
50 Gross farm income. Subtract line 49 from line 44. Enter the result here and on Part III, line 11 . .
50
*
If you use the unit-livestock-price method or the farm-price method of valuing inventory and the amount on line 48 is larger than the amount on line 47,
subtract line 47 from line 48. Enter the result on line 49. Add lines 44 and 49. Enter the total on line 50 and on Part III, line 11.
Part IV
Profit or Loss From Business (Sole Proprietorship)—See the Instructions for Schedule C (Form 1040).
Name of proprietor Social security number
Note: If you are filing a joint return and both you and your spouse had a profit or loss from a business, see Joint returns and Business
Owned and Operated by Spouses in the instructions for more information.
Section A—Income
1
Gross receipts $ Less returns and allowances $
Balance
1
2 a Inventory at beginning of year . . . . . . . . . . . . . . . . 2a
b Purchases less cost of items withdrawn for personal use . . . . . . . 2b
c Cost of labor. Don’t include any amounts paid to yourself . . . . . . . 2c
d Materials and supplies . . . . . . . . . . . . . . . . . . 2d
e Other costs (attach statement) . . . . . . . . . . . . . . . . 2e
f Add lines 2a through 2e . . . . . . . . . . . . . . . . . . 2f
g Inventory at end of year . . . . . . . . . . . . . . . . . . 2g
h Cost of goods sold. Subtract line 2g from line 2f . . . . . . . . . . . . . . . . . . 2h
3 Gross profit. Subtract line 2h from line 1 . . . . . . . . . . . . . . . . . . . . 3
4 Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross income. Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . .
5
Section B—Expenses
6 Advertising . . . . . . . 6
7 Car and truck expenses
(see instructions) . . . . . 7
8 Commissions and fees . . . 8
9 Contract labor . . . . . . 9
10 Depletion . . . . . . . .
10
11
Depreciation and section 179
expense deduction not claimed
elsewhere (attach Form 4562 if
required) . . . . . . . .
11
12 Employee benefit programs (other
than on line 17) . . . . . .
12
13 Insurance (other than health) . 13
14
Interest on business indebtedness
(see instructions) . . . . . 14
15
Legal and professional services .
15
16 Office expense . . . . . . 16
17 Pension and profit-sharing plans
17
18 Rent or lease:
a
Vehicles, machinery, and equipment
18a
b Other business property . . . 18b
19 Repairs and maintenance . . . 19
20
Supplies (not included in Section A)
20
21 Taxes and licenses . . . . . 21
22 Travel and meals:
a Travel . . . . . . . . . 22a
b Deductible meals . . . . . 22b
23 Utilities . . . . . . . . . 23
24 Wages not included on line 2c . 24
25 a Other expenses (list type and
amount):
b Total other expenses . . . .
25b
26 Total expenses. Add lines 6 through 25b . . . . . . . . . . . . . . . . . . .
26
27 Net profit or (loss). Subtract line 26 from line 5. Enter the result here and on Part V, line 2 . . . .
27
Form 1040-SS (2021)
DO NOT FILE
July 30, 2021
DRAFT AS OF
Form 1040-SS (2021)
Page 4
Part V Self-Employment Tax—If you had church employee income, see instructions before you begin.
Name of person with self-employment income
Social security number of person
with self-employment income
Note: If you are filing a joint return and both you and your spouse had self-employment income, you must each complete a separate
Part V.
A
If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had
$400 or more of other net earnings from self-employment, check here and continue with Part V . . . . . . . .
1 a Net farm profit or (loss) from Part III, line 36, and your distributive share from farm partnerships.
Note: Skip lines 1a and 1b if you use the farm optional method. See instructions . . . . . . . 1a
b
If you received social security retirement or disability benefits, enter the amount of Conservation
Reserve Program payments included on Part III, line 6, plus your distributive share of these payments
from farm partnerships . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
(
)
2
Net nonfarm profit or (loss) from Part IV, line 27, and your distributive share from nonfarm
partnerships. Ministers and members of religious orders, see instructions for amounts to report on
this line. See instructions for other income to report. Note: Skip this line if you use the nonfarm
optional method. See instructions . . . . . . . . . . . . . . . . . . . . . . .
2
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . 3
4 a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter the amount from line 3 4a
Note: If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see
instructions.
b If you elect one or both of the optional methods, enter the total of lines 2 and 4 of Part VI here . . . 4b
c
Combine lines 4a and 4b. If less than $400, stop; you don’t owe self-employment tax. Exception. If
less than $400 and you had church employee income, enter -0- and continue . . . . . . .
4c
5
a
Enter your church employee income from Form(s) W-2, W-2AS, W-2CM,
W-2GU, W-2VI, or 499R-2/W-2PR. See instructions for the definition of church
employee income . . . . . . . . . . . . . . . . . . . .
5a
b Multiply line 5a by 92.35% (0.9235). If less than $100, enter -0- . . . . . . . . . . . . . 5b
6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Maximum amount of combined wages and self-employment earnings subject to social security tax for
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
142,800
8
a
Total social security wages and tips from Form(s) W-2, W-2AS, W-2CM,
W-2GU, W-2VI, or 499R-2/W-2PR. If $142,800 or more, skip lines 8b through
10, and go to line 11 . . . . . . . . . . . . . . . . . . .
8a
b Unreported tips subject to social security tax from Form 4137, line 10 (see
instructions) . . . . . . . . . . . . . . . . . . . . . .
8b
c Wages subject to social security tax from Form 8919, line 10 (see instructions) 8c
d Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . . . . . . 8d
9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . . .
9
10 Multiply the smaller of line 6 or line 9 by 12.4% (0.124) . . . . . . . . . . . . . . . . 10
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Self-employment tax. Add lines 10 and 11. Enter here and on Part I, line 3 . . . . . . . . .
12
Part VI Optional Methods To Figure Net Earnings—See instructions for limitations.
Note: If you are filing a joint return and both you and your spouse choose to use an optional method to figure net earnings, you must
each complete and attach a separate Part VI.
Farm Optional Method
1 Maximum income for optional methods . . . . . . . . . . . . . . . . . . . . .
1
5,880
2
Enter the smaller of: two-thirds (
2
/3) of gross farm income (Part III, line 11, plus your distributive share
from farm partnerships), but not less than zero; or $5,880. Also, include this amount on Part V, line
4b, above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
Nonfarm Optional Method
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . .
3
4
Enter the smaller of: two-thirds (
2
/3) of gross nonfarm income (Part IV, line 5, plus your distributive
share from nonfarm partnerships), but not less than zero; or the amount on Part VI, line 3, above.
Also, include this amount on Part V, line 4b, above . . . . . . . . . . . . . . . . .
4
Form 1040-SS (2021)