1040-SS U.S. Self-Employment Tax Return (Including the Refundabl

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TREASURY/IRS AND OMB USE ONLY DRAFT
Form

1040-SS

U.S. Self-Employment Tax Return

OMB No. 1545-0074

(Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico)

2025

U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, or Puerto Rico
Department of the Treasury
For the year Jan. 1–Dec. 31, 2025, or other tax year beginning
, 2025, and ending
, 20
Internal Revenue Service
Filed pursuant to section 301.9100-2

Deceased

MM / DD / YYYY

Spouse

MM / DD / YYYY

Other
Your first name and middle initial

Last name

Your social security number

If a joint return, spouse’s first name and middle initial

Last name

Spouse’s social security number
Apt. no.

City, town, or post office. If you have a foreign address, also complete spaces below.

Commonwealth or territory

ZIP code

Foreign country name

Foreign province/state/county

Foreign postal code

At any time during 2025, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
exchange, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) . . .

Part I
1

Yes

No

Total Tax and Credits (see instructions)

Filing status.
Single
Married filing jointly
Married filing separately (MFS). Enter spouse’s SSN above and
full name here:

Head of household (HOH)
Qualifying surviving spouse (QSS)
If you checked the HOH box, and will not complete line 2,
enter the child’s name:

If treating a nonresident alien or dual-status alien spouse as a U.S. resident for the entire tax year, check the box and enter their
name (see instructions and attach statement if required):

2

Qualifying children. Complete only if you are a bona fide resident of Puerto Rico and you are claiming the additional child tax
credit (ACTC). If more than four qualifying children, see instructions and check here . . . . . . . . . . . . .
Qualifying child 1

Qualifying child 2

Qualifying child 3

Qualifying child 4

(a) First name
(b) Last name
(c) SSN
(d) Relationship

3

Self-employment tax from Schedule SE (Form 1040), line 12. Attach Schedule
SE (Form 1040) and applicable schedules . . . . . . . . . . . .
4
Household employment taxes. Attach Schedule H (Form 1040) . . . . .
5
Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . .
6a Employee social security and Medicare tax on tips not
6a
reported to employer. Attach Form 4137 . . . .
b Uncollected employee social security and Medicare tax
6b
on tips . . . . . . . . . . . . . . . .
c Uncollected employee social security and Medicare tax
6c
on wages. Attach Form 8919 . . . . . . . .
d Uncollected employee social security and Medicare tax
6d
on group-term life insurance
. . . . . . . .
e Total other taxes. Add lines 6a through 6d . . . . . . . . . . . .
7
Total tax. Add lines 3, 4, 5, and 6e . . . . . . . . . . . . . . .
8
2025 estimated tax payments and amount applied from 2024 return . . .
If you made estimated tax payments with your former spouse in 2025, enter
their SSN (see instructions):
9
Amount paid with request for extension of time to file . . . . . . . .
10
Additional child tax credit from Part II, line 19 . . . . . . . . . .
11a Additional Medicare Tax withheld. Attach Form 8959 . . . . . . . .
b Excess social security tax withheld . . . . . . . . . . . . . .
12
Total payments and credits. Add lines 8 through 11b . . . . . . . . .
For Disclosure, Privacy Act, and Paperwork Reduction
Act Notice, see instructions.

www.irs.gov/Form1040SS

3
4
5

6e
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8

9
10
11a
11b
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Cat. No. 17184B

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12

Form 1040-SS (2025) Created 8/22/25

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Home address (number and street). If you have a P.O. box, see instructions.

TREASURY/IRS AND OMB USE ONLY DRAFT
Page 2

Form 1040-SS (2025)

Part I
13
14a
b
d
15
16

Total Tax and Credits (see instructions) (continued)

If line 12 is more than line 7, subtract line 7 from line 12. This is the amount you overpaid . . . .
Amount of line 13 you want refunded to you. If Form 8888 is attached, check here . . . . .
Routing number
c Type:
Checking
Savings
Account number
Amount of line 13 you want applied to 2026 estimated tax . . . . . .
15
If line 7 is more than line 12, subtract line 12 from line 7. This is the amount you owe.
For details on how to pay, go to www.irs.gov/Payments or see instructions . . . . . . . . .

Third Party
Designee

Joint return?
See instructions.
Keep a copy
for your records.

Paid
Preparer
Use Only

16

Yes. Complete the following.

No

Personal
Designee’s
Phone
identification
name
no.
number (PIN)
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.

Preparer’s name

Preparer’s signature

Date

If the IRS sent your spouse an Identity Protection
PIN, enter it here
(see instructions)
Date

PTIN

Check if:
Self-employed

Firm’s name

Phone no.

Firm’s address

Firm’s EIN
Form 1040-SS (2025)

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Sign
Here

Do you want to allow another person to discuss this return with the IRS? See instructions.

13
14a

TREASURY/IRS AND OMB USE ONLY DRAFT
Page 3

Form 1040-SS (2025)

Part II
1

Do you have one or more qualifying children under age 17 with the required social security number?
No. Stop. You can’t claim the credit.
Yes. Go to line 2.
Number of qualifying children under age 17 with the required social security number:
x $1,700 . . . . . . . . . . . . . . . . . . . . . . . .
Enter your modified adjusted gross income . . . . . . . . . . . .
3
Enter the amount shown below for your filing status . . . . . . . . .
4
• Married filing jointly – $400,000
• All other filing statuses – $200,000
Is the amount on line 3 more than the amount on line 4?
No. Leave line 5 blank. Enter the amount from line 2 on line 11, and go to
line 12.

2
3
4

5

Yes. Subtract line 4 from line 3. If the result isn’t a multiple of $1,000,
increase it to the next multiple of $1,000 (for example, increase $425 to
$1,000, increase $1,025 to $2,000, etc.)
. . . . . . . . . . .
6
Multiply the amount on line 5 by 5% (0.05) . . . . . . . . . . . . .
7
Number of qualifying children from line 2 x $2,200 . . . . . . . . .
8
Number of other dependents, including children who are not under age 17:
x $500. See instructions . . . . . . . . . . .
9
Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . .
10
Is the amount on line 9 more than the amount on line 6?
No. Stop. You can’t claim the credit.
Yes. Subtract line 6 from line 9 . . . . . . . . . . . . . . .
11
Enter the smaller of line 2 or line 10 . . . . . . . . . . . . . . .
12a Enter one-half of self-employment tax from Part I, line 3 . . . . . . .
b Enter one-half of the Additional Medicare Tax on self-employment income
from Form 8959, line 13 . . . . . . . . . . . . . . . . . .
c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . .
13a Enter the amount, if any, of withheld social security, Medicare, and Additional
Medicare taxes from Puerto Rico Form(s) 499R-2/W-2PR (attach copy of
form(s)). If married filing jointly, include your spouse’s amounts with yours .

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7

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11

13d
Enter the amount, if any, of Additional Medicare Tax on Medicare wages from
Form 8959, line 7 . . . . . . . . . . . . . . . . . . . .
13e
Add lines 13a through 13e . . . . . . . . . . . . . . . . .
13f
Add lines 12c and 13f . . . . . . . . . . . . . . . . . . .
14
Enter the amount, if any, of Additional Medicare Tax withheld from Form 8959,
line 22 . . . . . . . . . . . . . . . . . . . . . . . .
15
Subtract line 15 from line 14
. . . . . . . . . . . . . . . .
16
Enter the amount, if any, from Part I, line 11b . . . . . . . . . . .
17
Is the amount on line 16 more than the amount on line 17?
No. Stop. You can’t claim the credit.
Yes. Subtract line 17 from line 16 . . . . . . . . . . . . . . . . . . .
Additional child tax credit. Enter the smaller of line 11 or line 18 here and on Part I, line 10

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18
19

b Enter the amount reported on Part I, line 6a, if any, of employee social security
and Medicare tax on tips not reported to employer from Form 4137 . . . .
c Enter the amount reported on Part I, line 6c, if any, of uncollected employee
social security and Medicare tax on wages from Form 8919 . . . . . .

8
9

. .
. .
12a
12b
12c

13a
13b
13c

d Enter the amounts reported on Part I, lines 6b and 6d, if any, of uncollected
employee social security tax and Medicare tax on tips and group-term life
insurance . . . . . . . . . . . . . . . . . . . . . . .
e
f
14
15
16
17
18

19

Form 1040-SS (2025)

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Bona Fide Residents of Puerto Rico Claiming Additional Child Tax Credit (see instructions)