Schedule R (Form 1 Credit for the Elderly or the Disabled

Schedule R
(Form 1040A
or 1040)

Credit for the Elderly or the Disabled

1040A

2011

..........

1040
Complete and attach to Form 1040A or 1040.

Department of the Treasury
Internal Revenue Service (99)
Name(s) shown on Form 1040A or 1040

OMB No. 1545-0074

◀

R

Attachment
Sequence No. 16
Your social security number

You may be able to take this credit and reduce your tax if by the end of 2011:
• You were age 65 or older
or
• You were under age 65, you retired on permanent and total disability, and
you received taxable disability income.
But you must also meet other tests. See instructions.
TIP

In most cases, the IRS can figure the credit for you. See instructions.

Part I
Check the Box for Your Filing Status and Age
If your filing status is:
And by the end of 2011:
Single,
Head of household, or
Qualifying widow(er)

Check only one box:

1 You were 65 or older . . . . . . . . . . . . . . . . . . . .

1

2 You were under 65 and you retired on permanent and total disability

. .

2

3 Both spouses were 65 or older . . . . . . . . . . . . . . . . .

3

4 Both spouses were under 65, but only one spouse retired on permanent and
4
total disability . . . . . . . . . . . . . . . . . . . . . . .
Married filing
jointly

5 Both spouses were under 65, and both retired on permanent and total
5
disability . . . . . . . . . . . . . . . . . . . . . . . . .
6 One spouse was 65 or older, and the other spouse was under 65 and retired
6
on permanent and total disability . . . . . . . . . . . . . . . .
7 One spouse was 65 or older, and the other spouse was under 65 and not
7
retired on permanent and total disability . . . . . . . . . . . . .

Married filing
separately

Did you check
box 1, 3, 7, or
8?

8 You were 65 or older and you lived apart from your spouse for all of 2011 .

8

9 You were under 65, you retired on permanent and total disability, and you
9
lived apart from your spouse for all of 2011 . . . . . . . . . . . .
Yes

▶

Skip Part II and complete Part III on the back.

No

▶

Complete Parts II and III.

Part II
Statement of Permanent and Total Disability (Complete only if you checked box 2, 4, 5, 6, or 9 above.)
If: 1 You filed a physician’s statement for this disability for 1983 or an earlier year, or you filed or got a
statement for tax years after 1983 and your physician signed line B on the statement, and

2 Due to your continued disabled condition, you were unable to engage in any substantial gainful activity
in 2011, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶
• If you checked this box, you do not have to get another statement for 2011.
• If you did not check this box, have your physician complete the statement in the instructions. You must
keep the statement for your records.
For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 11359K

Schedule R (Form 1040A or 1040) 2011

Page 2

Schedule R (Form 1040A or 1040) 2011

Part III
Figure Your Credit
10 If you checked (in Part I):
Enter:
Box 1, 2, 4, or 7 . . . . . . . . . . . . $5,000
Box 3, 5, or 6 . . . . . . . . . . . . . $7,500
Box 8 or 9 . . . . . . . . . . . . . . $3,750
Did you check
box 2, 4, 5, 6,
or 9 in Part I?
11

}

.

.

.

.

.

.

.

.

Yes

▶ You must complete line 11.

No

▶ Enter the amount from line 10

.

.

on line 12 and go to line 13.
If you checked (in Part I):
• Box 6, add $5,000 to the taxable disability income of the
spouse who was under age 65. Enter the total.
. . . . . . .
• Box 2, 4, or 9, enter your taxable disability income.
• Box 5, add your taxable disability income to your spouse’s
taxable disability income. Enter the total.

}

10

11

For more details on what to include on line 11, see Figure Your Credit in the instructions.

TIP

12

If you completed line 11, enter the smaller of line 10 or line 11. All others, enter the
amount from line 10 . . . . . . . . . . . . . . . . . . . . . . . . .
13 Enter the following pensions, annuities, or disability income that
you (and your spouse if filing jointly) received in 2011.
a Nontaxable part of social security benefits and nontaxable part
of railroad retirement benefits treated as social security (see
instructions). . . . . . . . . . . . . . . . . . . . 13a
b Nontaxable veterans’ pensions and any other pension, annuity,
or disability benefit that is excluded from income under any
other provision of law (see instructions). . . . . . . . . .

12

13b

c Add lines 13a and 13b. (Even though these income items are
not taxable, they must be included here to figure your credit.) If
you did not receive any of the types of nontaxable income listed
on line 13a or 13b, enter -0- on line 13c . . . . . . . . . 13c
14 Enter the amount from Form 1040A, line
14
22, or Form 1040, line 38 . . . . .
15 If you checked (in Part I):
Enter:
Box 1 or 2 . . . . . .
$7,500
15
Box 3, 4, 5, 6, or 7 . . .
$10,000
Box 8 or 9 . . . . . .
$5,000
16 Subtract line 15 from line 14. If zero or
16
less, enter -0- . . . . . . . . .
17 Enter one-half of line 16 . . . . . . . . . . . . . . . 17

}

18
19
20
21
22

Add lines 13c and 17 . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 18 from line 12. If zero or less, stop; you cannot take the credit. Otherwise,
go to line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Multiply line 19 by 15% (.15). . . . . . . . . . . . . . . . . . . . . . .
Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions .
Credit for the elderly or the disabled. Enter the smaller of line 20 or line 21. Also enter
this amount on Form 1040A, line 30, or include on Form 1040, line 53 (check box c and
enter "Sch R" on the line next to that box) . . . . . . . . . . . . . . . . .

18
19
20
21
22

Schedule R (Form 1040A or 1040) 2011