Instructions For Schedule R (Form 1040a Or 1040)

years after 1983 and your physician signed on line B

ble disability income that he reports on Form 1040,

of the statement, you do not have to get another

line 7. He is filing jointly with his wife who was age

statement for 2012. But you must check the box on

67 in 2012, and he checked box 6 in Part I. On

line 2 in Part II to certify all three of the following.

line 11, Bill enters $9,000 ($5,000 plus the $4,000 of

disability income he reports on Form 1040, line 7).

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

earlier year.

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

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

2. You were permanently and totally disabled

disability income, which he enters on line 11. John

during 2012.

also enters $3,000 on line 12 (the smaller of line 10

3. You were unable to engage in any substantial

or line 11). The largest amount he can use to figure

gainful activity during 2012 because of your physi-

the credit is $3,000.

cal or mental condition.

Lines 13a Through 18

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

space above the box on line 2 in Part II the first

The amount on which you figure your credit can be

name(s) of the spouse(s) for whom the box is

reduced if you received certain types of nontaxable

checked.

pensions, annuities, or disability income. The

amount can also be reduced if your adjusted gross

If the Department of Veterans Affairs (VA) certi-

income is over a certain amount, depending on

fies that you are permanently and totally disabled,

which box you checked in Part I.

you can use VA Form 21-0172 instead of the physi-

Line 13a. Enter any social security benefits (before

cian's statement. VA Form 21-0172 must be signed

deduction of Medicare premiums) you (and your

by a person authorized by the VA to do so. You can

spouse if filing jointly) received for 2012 that are not

get this form from your local VA regional office.

taxable. Also, enter any tier 1 railroad retirement

benefits treated as social security that are not taxa-

Part III. Figure Your Credit

ble.

If any of your social security or equivalent rail-

Line 11

road retirement benefits are taxable, the amount to

enter on this line is generally the difference between

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

the amounts entered on Form 1040A, line 14a and

following chart to complete line 11.

line 14b, or Form 1040, line 20a and line 20b.

If your social security or equivalent railroad

IF you checked . . .

THEN enter on line 11 . . .

retirement benefits are reduced because of

workers' compensation benefits, treat the

CAUTION

Box 6

The total of $5,000 plus the

workers' compensation benefits as social security

disability income you reported on

benefits when completing Schedule R (Form 1040A

Form 1040A or 1040 for the spouse

or 1040), line 13a.

who was under age 65.

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

Box 2, 4, or 9

The total amount of disability

income that you (and your spouse if filing jointly)

income you reported on Form

received for 2012.

1040A or 1040.

Veterans' pensions (but not military disability

Box 5

The total amount of disability

pensions).

income you reported on Form

Any other pension, annuity, or disability benefit

1040A or 1040 for both you and

that is excluded from income under any provision of

your spouse.

federal law other than the Internal Revenue Code.

Do not include amounts that are treated as a return

of your cost of a pension or annuity.

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

total disability in 2012. He received $4,000 of taxa-

Credit Limit Worksheet—Line 21

Keep for Your Records

Use this worksheet to figure your credit limit.

1. Enter the amount from Form 1040A, line 28; or Form 1040, line 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

2. Enter the amount from Form 1040A, line 29; or Form 1040, lines 47 and 48 . . . . . . . . . . . . . . . . . . . . 2.

3. Subtract line 2 from line 1. Enter this amount on Schedule R (Form 1040A or 1040), line 21. But if

zero or less, STOP, you cannot take this credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.

R-3

Instructions For Schedule R (Form 1040a Or 1040) - 2012 Page 3

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