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General Information

Tax Year

Name(s) shown on Form 1040, 1040-SR, or 1040-NR

Your social security number

Part I: Additional Income

1. Taxable refunds, credits, or offsets of state and local income taxes

2a. Alimony received

2b. Date of original divorce or separation agreement

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3. Business income or (loss).

4. Other gains or (losses)

5. Rental real estate, royalties, partnerships, S corporations, trusts, etc

6. Farm income or (loss)

7. Unemployment compensation

8. Other Income

8. Other Income
Income Description 8a. Net operating loss 8a. Net operating loss 8b. Gambling 8c. Cancellation of debt 8d. Foreign earned income exclusion from Form 2555 8e. Income from Form 8853 8f. Income from Form 8889 8g. Alaska Permanent Fund dividends 8h. Jury duty pay 8i. Prizes and awards 8j. Activity not engaged in for profit income 8k. Stock Options 8l. Income from the rental of personal property if you engaged in the rental for profit but were not in the business of renting such property 8m. Olympic and Paralympic medals and USOC prize money 8n. Section 951(a) inclusion 8o. Section 951A(a) inclusion 8p. Section 461(l) excess business loss adjustment 8q. Taxable distributions from an ABLE account 8r. Scholarship and fellowship grants not reported on Form W-2. 8s. Nontaxable amount of Medicaid waiver payments included on Form 1040, line 1a or 1d. 8t. Pension or annuity from a nonqualified deferred compensation plan or a nongovernmental section 457 plan 8u. Wages earned while incarcerated 8z. Other income Net operating loss (NOL) deduction. Enter on line 8a any NOL deduction from an earlier year. Enter the amount in the preprinted parentheses (as a negative number). The amount of your deduction will be subtracted from the other amounts of income listed on lines 8b through 8z. See Pub. 536 for details.
Enter Amount , numeric only, $

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line8a line8b line8c	line8d line8d line8e	line8f line8f line8f line8g	line8h line8i line8j	line8k line8l line8m	line8n line8o line8p	line8q line8r line8s	line8t line8u line8z line8z1

9. Total other income. Add lines 8a through 8z

10. Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8

Part II: Adjustments to Income

11. Educator expenses

12. Certain business expenses of reservists, performing artists, and fee-basis government officials

13. Health savings account deduction

14. Moving Expenses

15. Deductible part of self-employment tax

16. Self-employed SEP, SIMPLE, and qualified plans

17. Self-employed health insurance deduction

18. Penalty on early withdrawal of savings

19a. Alimony Paid

19b. Recipient’s SSN

19c. Date of original divorce or separation agreement

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20. IRA deduction

21. Student loan interest deduction

23. Archer MSA deduction

24. Other Adjustments

24. Other Adjustments
Adjustment Description 24a. Jury duty pay 24a. Jury duty pay 24b. Deductible expenses related to income reported on line 8l 24c. Nontaxable amount of the value of Olympic and Paralympic medals and USOC prize money reported on line 8m 24d. Reforestation amortization and expenses 24e. Repayment of supplemental unemployment benefits under the Trade Act of 1974 24f. Contributions to section 501(c)(18)(D) pension plans 24g. Contributions by certain chaplains to section 403(b) plans 24h. Attorney fees and court costs for actions involving certain unlawful discrimination claims 24i. Attorney fees and court costs you paid in connection with an award from the IRS for information you provided that helped the IRS detect tax law violations 24j. Housing deduction from Form 2555 24k. Excess deductions of section 67(e) expenses from Schedule K-1 (Form 1041) 24z. Other adjustments Enter your jury duty pay if you gave the pay to your employer because your employer paid your salary while you served on the jury
Enter Amount , numeric only, $

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Table
line24a line24b	line24c line24d	line24e line24f	line24g line24h	line24i line24j	line24k line24z line24z1

25. Total other adjustments. Add lines 24a through 24z

26. Add lines 11 through 23 and 25. These are your adjustments to income. Enter here and on Form 1040 or 1040-SR, line 10, or Form 1040-NR, line 10a

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