Form 4563: Excluding Income From American Samoa
Published November 7, 2026
Form 4563 is used to figure the amount of income from American Samoa that a bona fide resident may exclude from gross income. You attach the form to your Form 1040 or Form 1040-SR.
This post is general information from the form (Rev. September 2024). It does not tell you whether you qualify.
Who may use the exclusion
The form says you generally qualify if you were a bona fide resident of American Samoa for the entire tax year, and your income was from sources within American Samoa or was effectively connected with a trade or business there.
The form also says you may not exclude amounts paid for services you performed as an employee of the U.S. government or any of its agencies. That rule applies to both civilian and military employees. It does not cover employees of the American Samoa government. Read the rules for your own situation before you claim the exclusion.
Part I: general information
Part I asks for the dates your bona fide residence began and ended. It asks what kind of living quarters you had in American Samoa, such as a rented room, a rented house or apartment, quarters furnished by an employer, or a purchased home.
It asks whether your family lived with you in American Samoa during any part of the year. It asks whether you kept a home outside the territory. It also asks for your employer's name and address, or whether you were self-employed.
Line 6 is a table of days you were absent from American Samoa. For each absence, list the date you left, the date you returned, the number of days absent, and the reason.
Part II: the income to exclude
Lines 7 through 14 list the income types: wages, salaries, and tips; taxable interest; ordinary dividends; business income; capital gain; rental real estate and royalties; farm income; and other income. Include only income from American Samoa sources, or income effectively connected with a trade or business there.
Line 15 adds lines 7 through 14. That total is the amount you may exclude from gross income for the year.
Source rules
The form gives general source rules. Wages are generally sourced where the services are performed. Interest is generally sourced where the payer is located. Dividends are generally sourced where the paying corporation is created or organized. The instructions and Publication 570 explain the exceptions.
Deductions and credits
If you claim the exclusion, you cannot take any deduction or credit that is directly related to the excluded income. Deductions that are not related to a particular type of income must be divided between the excluded and the other income. The form gives examples, such as the standard deduction, and some itemized deductions, such as medical expenses and mortgage interest on a personal residence.
Self-employment tax
The form says that if you were self-employed and your net earnings from self-employment were $400 or more, you generally must pay self-employment tax on those earnings, even when you can exclude them from gross income. Use Schedule SE to figure that tax.
Form 8898 and the penalty
If you became or stopped being a bona fide resident of a U.S. territory, you may have to file Form 8898. If you do not provide the required information, the form warns of a $1,000 penalty for each failure, unless you show the failure was due to reasonable cause and not willful neglect. For the territory rules, see Form 8898: Who Files It When You Move To or From a U.S. Territory.
Filing checklist
- Confirm the entire-year residence test and write the dates in Part I.
- Gather the records for each income line in Part II.
- Complete the days-absent table in line 6.
- List the deductions that are directly related to the excluded income, and divide the others.
- Attach Form 4563 to the Form 1040 or Form 1040-SR you file.
For the general territory rules, see Income From a U.S. Territory: Basic Filing Rules.
This is general information only. It is not tax advice for your situation.
Sources: Sources: IRS, Form 4563, Exclusion of Income for Bona Fide Residents of American Samoa (Rev. September 2024) (https://www.irs.gov/pub/irs-pdf/f4563.pdf) This is general information, not advice about your specific return.
