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1. You filed or got a physician's statement in an earli-

ty income, which he enters on line 11. John also enters

er year.

$3,000 on line 12 (the smaller of line 10 or line 11). The

largest amount he can use to figure the credit is $3,000.

2. You were permanently and totally disabled during

Lines 13a Through 18

2015.

3. You were unable to engage in any substantial gain-

The amount on which you figure your credit can be re-

ful activity during 2015 because of your physical or men-

duced if you received certain types of nontaxable pen-

tal condition.

DRAFT AS OF

sions, annuities, or disability income. The amount can al-

If you checked box 4, 5, or 6 in Part I, enter in the

so be reduced if your adjusted gross income is over a cer-

space above the box on line 2 in Part II the first name(s)

tain amount, depending on which box you checked in

of the spouse(s) for whom the box is checked.

Part I.

If the Department of Veterans Affairs (VA) certifies

Line 13a. Enter any social security benefits (before de-

August 14, 2015

that you are permanently and totally disabled, you can

duction of Medicare premiums) you (and your spouse if

use VA Form 21-0172 instead of the physician's state-

filing jointly) received for 2015 that are not taxable. Al-

ment. VA Form 21-0172 must be signed by a person au-

so, enter any tier 1 railroad retirement benefits treated as

thorized by the VA to do so. You can get this form from

social security that are not taxable.

your local VA regional office.

If any of your social security or equivalent railroad re-

tirement benefits are taxable, the amount to enter on this

line is generally the difference between the amounts en-

Part III. Figure Your Credit

tered on Form 1040A, line 14a and line 14b, or Form

1040, line 20a and line 20b.

Line 11

If your social security or equivalent railroad re

If you checked box 2, 4, 5, 6, or 9 in Part I, use the fol-

tirement benefits are reduced because of work

lowing chart to complete line 11.

ers' compensation benefits, treat the workers'

CAUTION

compensation benefits as social security benefits when

IF you checked . . .

THEN enter on line 11 . . .

completing Schedule R (Form 1040A or 1040), line 13a.

Box 6

The total of $5,000 plus the disability

Line 13b. Enter the total of the following types of in-

income you reported on Form 1040A

come that you (and your spouse if filing jointly) received

or 1040 for the spouse who was under

for 2015.

age 65.

Veterans' pensions (but not military disability pen-

Box 2, 4, or 9

The total amount of disability income

sions).

you reported on Form 1040A or 1040.

Any other pension, annuity, or disability benefit that

is excluded from income under any provision of federal

Box 5

The total amount of disability income

law other than the Internal Revenue Code. Do not include

you reported on Form 1040A or 1040

for both you and your spouse.

amounts that are treated as a return of your cost of a pen-

sion or annuity.

Do not include on line 13b any pension, annuity, or

similar allowance for personal injuries or sickness result-

Example 1. Bill, age 63, retired on permanent and total

ing from active service in the armed forces of any coun-

disability in 2015. He received $4,000 of taxable disabili-

try, or in the National Oceanic and Atmospheric Admin-

ty income that he reports on Form 1040, line 7. He is fil-

istration or the Public Health Service. Also, do not in-

ing jointly with his wife who was age 67 in 2015, and he

clude a disability annuity payable under section 808 of

checked box 6 in Part I. On line 11, Bill enters $9,000

the Foreign Service Act of 1980.

($5,000 plus the $4,000 of disability income he reports

on Form 1040, line 7).

Example 2. John checked box 2 in Part I and enters

$5,000 on line 10. He received $3,000 of taxable disabili-

R-3

Form 1040a Or 1040(Draft) - Instructions For Schedule R - Credit For The Elderly Or The Disabled (2015) Page 4

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