Since this is your first year filing taxes in Italy, there is one critical thing your commercialista should explain — and that most first-year filers are not warned about: the acconto IRPEF (advance tax payment).
In Italy, you don't just pay tax on the year you just filed. You also prepay an estimate of next year's tax — typically 100% of the IRPEF you owed this year — split into two installments:
- First acconto — typically 40% of your IRPEF, due 30 June (paid together with the saldo for the year just filed)
- Second acconto — the remaining 60%, due 30 November
💡 Ask your commercialista to calculate the total amount due in June and November so you can plan cash flow. If your income is dropping (e.g., one-time income last year), you may be able to reduce the acconto via the metodo previsionale.
To download it: log in to the Agenzia delle Entrate Area Riservata (SPID / CIE / CNS) → Cassetto fiscale → "Dichiarazioni fiscali" → choose Modello Redditi or 730 → "Annualità disponibili" → select the year.
First year in Italy? There's no prior Italian return to download yet — your commercialista builds the baseline from your U.S. 1040 and income documents instead.
• Format: an official fattura or ricevuta fiscale from the doctor, clinic, or hospital.
• Payment: private (non-SSN) expenses must be paid by traceable means — card, bank transfer, or app — to be deductible. Medicines, medical devices, and public SSN facilities are exempt and may be paid in cash.
• Dental: private dentist invoices need a card / electronic payment record to qualify.
• Glasses: optician receipts must state "Dispositivo Medico" (CE-compliant) and specify corrective lenses.
⚠️ Always request your receipt with your Codice Fiscale at the time of payment — asking after the fact is often not possible, and without it the expense cannot be claimed for a deduction.
📥 Download your recorded health expenses: The Sistema Tessera Sanitaria automatically transmits medical receipts to the Agenzia delle Entrate under your Codice Fiscale. You can download a full spreadsheet of your health costs at sistemats1.sanita.finanze.it → Area Riservata Cittadino (login with SPID or CIE). Important caveat: not all receipts will appear — depending on your privacy preference (opzione di oscuramento), the individual health institution, and their coordination with Agenzia delle Entrate, some receipts may not have been transmitted. Always cross-check with your physical receipts.
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To download a prior return: Agenzia delle Entrate Area Riservata (SPID / CIE / CNS) → Cassetto fiscale → "Dichiarazioni fiscali" → Modello Redditi → "Annualità disponibili" → select the year.
First year in Italy? No prior Italian return exists yet — your commercialista builds the baseline from your U.S. 1040 and income documents.
• Format: an official fattura or ricevuta fiscale from the doctor, clinic, or hospital.
• Payment: private (non-SSN) expenses must be paid by traceable means — card, bank transfer, or app. Medicines, medical devices, and public SSN facilities are exempt and may be paid in cash.
• Dental: private dentist invoices need a card / electronic payment record to qualify.
• Glasses: optician receipts must state "Dispositivo Medico" (CE-compliant) and specify corrective lenses.
⚠️ Always request your receipt with your Codice Fiscale at the time of payment — asking after the fact is often not possible, and without it the expense cannot be claimed for a deduction.
📥 Download your recorded health expenses: The Sistema Tessera Sanitaria automatically transmits medical receipts to the Agenzia delle Entrate under your Codice Fiscale. You can download a full spreadsheet of your health costs at sistemats1.sanita.finanze.it → Area Riservata Cittadino (login with SPID or CIE). Important caveat: not all receipts will appear — depending on your privacy preference (opzione di oscuramento), the individual health institution, and their coordination with Agenzia delle Entrate, some receipts may not have been transmitted. Always cross-check with your physical receipts.
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Under the U.S.–Italy tax treaty, U.S. Social Security paid to an Italian resident is taxable only in Italy (Article 18), and U.S. government/military pensions are taxable only in the U.S. (Article 19).
Because the U.S. taxes its citizens on worldwide income, claiming the Social Security benefit on your U.S. return isn't automatic — it depends on the treaty's "saving clause" and is usually handled through the Foreign Tax Credit or a treaty-based return position (Form 8833). Some filers use a U.S. address, file on paper rather than electronically, and attach excerpts of the treaty plus proof of Italian residency to document the position.
English (IRS): irs.gov — Italy tax treaty documents
Italian (Gazzetta Ufficiale / MEF): finanze.gov.it — testo della Convenzione (PDF)