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IRS.gov Website
Instructions for Schedule R (Form 1040A or 1040)
taxmap/instr/i1040sr-002.htm#en_us_publink11357od0e383

Part III. Figure Your Credit(p3)

rule
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Line 11(p3)

rule
If you checked box 2, 4, 5, 6, or 9 in Part I, use the following chart to complete line 11.
IF you checked . . .THEN enter on line 11 . . .
Box 6The total of $5,000 plus the disability income you reported on Form 1040A or 1040 for the spouse who was under age 65.
Box 2, 4, or 9The total amount of disability income you reported on Form 1040A or 1040.
Box 5The total amount of disability income you reported on Form 1040A or 1040 for both you and your spouse.
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Example 1.(p3)
rule
Bill, age 63, retired on permanent and total disability in 2014. He received $4,000 of taxable disability income that he reports on Form 1040, line 7. He is filing jointly with his wife who was age 67 in 2014, and he checked box 6 in Part I. On line 11, Bill enters $9,000 ($5,000 plus the $4,000 of disability income he reports on Form 1040, line 7).
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Example 2.(p3)
rule
John checked box 2 in Part I and enters $5,000 on line 10. He received $3,000 of taxable disability income, which he enters on line 11. John also enters $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.
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Lines 13a Through 18(p3)

rule
The amount on which you figure your credit can be reduced if you received certain types of nontaxable pensions, annuities, or disability income. The amount can also be reduced if your adjusted gross income is over a certain amount, depending on which box you checked in Part I.
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Line 13a.(p3)
rule
Enter any social security benefits (before deduction of Medicare premiums) you (and your spouse if filing jointly) received for 2014 that are not taxable. Also, enter any tier 1 railroad retirement benefits treated as social security that are not taxable.
If any of your social security or equivalent railroad retirement benefits are taxable, the amount to enter on this line is generally the difference between the amounts entered on Form 1040A, line 14a and line 14b, or Form 1040, line 20a and line 20b.
caution
If your social security or equivalent railroad retirement benefits are reduced because of workers' compensation benefits, treat the workers' compensation benefits as social security benefits when completing Schedule R (Form 1040A or 1040), line 13a.
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Line 13b.(p3)
rule
Enter the total of the following types of income that you (and your spouse if filing jointly) received for 2014.
Do not include on line 13b any pension, annuity, or similar allowance for personal injuries or sickness resulting from active service in the armed forces of any country, or in the National Oceanic and Atmospheric Administration or the Public Health Service. Also, do not include a disability annuity payable under section 808 of the Foreign Service Act of 1980.
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pencil

Credit Limit Worksheet—Line 21

Use this worksheet to figure your credit limit.

1.Enter the amount from Form 1040A, line 30; or Form 1040, line 471.  
2.Enter the amount from Form 1040A, line 31; or Form 1040, lines 48 and 492. 
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. 
       
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Instructions for Physician's Statement

TaxpayerPhysician
If you retired after 1976, enter the date you retired in the space provided on the statement below.A person is permanently and totally disabled if both of the following apply.
  1. He or she cannot engage in any substantial gainful activity because of a physical or mental condition.
  2. A physician determines that the disability has lasted or can be expected to last continuously for at least a year or can lead to death.
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Physician's Statement

 I certify that                                         
   Name of disabled person 
was permanently and totally disabled on January 1, 1976, or January 1, 1977, or was permanently and totally disabled on the date he or she retired. If retired after 1976, enter the date retired. ▸               
Physician: Sign your name on either line A or B below.
AThe disability has lasted or can be expected to last continuously for at least a year
   Physician's signatureDate
BThere is no reasonable probability that the disabled condition will ever improve
   Physician's signatureDate
Physician's name Physician's address