Form D-2440 - Disability Income Exclusion - 2015 Page 2
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1
2What is the purpose of Form D-2440?
Income and Limitation on Exclusion
Form D-2440 is used to determine the amount of disability income
you may exclude from the federal adjusted gross income you report
Line 1 Total amount of disability payments received in 2015
on DC Form D-40. Enter the amount from Line 10 of this form on
Enter the total amount of disability payments you received in 2015.
Line 2 of Calculation B of Schedule I. The maximum annual exclu-
Do not include any lump-sum payment received for accrued annual
sion per disabled person is $5,200.
leave when you retired on disability. (The annual leave payment is
included in your gross income for the year of receipt.) Payments
Who may file a Form D-2440?
from a retirement plan or profit-sharing plan that does not have a
You must meet all of the following requirements:
provision for disability retirement do not qualify for the exclusion.
• You are not filing a Form D-40EZ;
Line 2
• If you are married or registered domestic partners, you are filing
If you received disability payments for part of a week, follow the
a joint return;
example below to determine the exclusion for that portion:
• You received disability payments during 2015;
Divide $100 by the number of days in a week you normally worked
• You were under the age of 65 on December 31, 2015;
before you retired and multiply the result by the number of days you
• You retired on disability and were permanently and totally disabled
were paid for the partial week.
when you retired;
Example: $100 divided by 5 days (number of days in typical work
• On January 1, 2015, you had not reached the age required to
week) = $20. $20 x 3 (number of days you were paid for partial
retire under your employer’s retirement program; and
week) = $60. Add this amount to the total amount you were paid
for the full weeks.
• You have not notified the Office of Tax and Revenue that you have
chosen to treat the disability income as a pension.
Line 8 Amount used to reduce disability income
$15,000 is the amount DC uses to reduce the disability income
Personal information
you can exclude.
Line 10 Disability income exclusion
If you are filing a joint return, please provide the information re-
This is the amount you may use to reduce your DC taxable income.
quested for you and your spouse/registered domestic partner, even
$5,200 is the maximum annual amount per disabled person that
if your spouse/registered domestic partner is not disabled and is not
may be excluded.
claiming a disability exclusion.
Physician’s certification
To claim an exclusion, your physician must certify that you are, accord-
ing to the definition below, permanently disabled. If both you and your
spouse/registered domestic partner are claiming the exclusion, each
must file a certification. You do not have to file another certification
if you have filed one in a previous year. Attach the certification(s) to
your Form D-40.
Instructions for the Physician
Date taxpayer retired
Definition of permanent and total disability
Please certify that the taxpayer ceased active employment because
Permanent and total disability means that the taxpayer is unable to
of his or her permanent disability and retired on the date that he
engage in any substantial gainful activity because of a physical or
or she became disabled.
mental condition and this condition has lasted continuously for at
least a year, will last continuously for at least a year, or is fatal.
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