1040 Schedule 1 Form

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1/4 Personal Information

Year of filing i

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

Social Security Number (SSN) i

2/4

Part I: Additional Income

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

2a. Alimony received i

2b. Date of original divorce or separation agreement i

3. Business income or (loss) i

4. Other gains or (losses) i

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

6. Farm income or (loss) i

7. Unemployment compensation i

8. Other income

Income Description * i

Enter the amount of income * i

Income Description * i

Enter the amount of income * i

3

Part II: Adjustments to Income

11. Educator expenses i

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

13. Health savings account deduction i

14. Moving expenses i

15. Deductible part of self-employment tax i

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

17. Self-employed health insurance deduction i

18. Penalty on early withdrawal of savings i

19a. Alimony paid i

19b. Recipient’s SSN i

19c. Date of original divorce or separation agreementi

20. IRA deduction i

21. Student loan interest deduction i

22. Archer MSA deduction i

24. Other adjustments

Adjustment Description * i

Enter the amount of adjustment * i

Adjustment Description * i

Enter the amount of adjustment * i

4/4 Submit

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1040 Schedule 1 Form

1/4 Personal Information

2/4

Part I: Additional Income

3

Part II: Adjustments to Income

4/4 Submit

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