Form Schedule 2440W Disability Income Exclusion and Instructions | Fill-In Form
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$20 200 or more and one person could take the exclusion $25 400 or more and both husband and wife could take the (1) The disability retirement begins (1) The first day of the tax year in which you turn 65 (If you were (2) The day you reach the age when your employer s retirement (2) The disability retirement ends because the taxpayer reaches (3) The taxpayer dies (a) Fill in adjusted gross income from federal Form 1040 1040A or 1040EZ 5a (a) Multiply $100 by the number of weeks for which your disability payments (b) Amount used to figure any exclusion decrease 5b (b) If you received disability payments of less than $100 for any week (c) If you received disability payments for less than a week fill in the (c) Subtract line 5b from line 5a If line 5b is more than line 5a fill in 0 5c (d) Add lines 2a 2b and 2c Fill in the total 2d (Part year residents complete lines 7 and 8 below ) 6 A person is permanently and totally disabled when A physician determines that the condition (1) has lasted or can be A physician determines that the disability (a) has A Purpose of Schedule Persons who receive disability income may An activity is considered substantial if it consists of duties that are B What is Disability Income Generally disability income is the Box (1) applies to taxpayers who Box (2) applies to taxpayers who C Who Can Exclude Disability Income You can take the D What is Permanent and Total Disability? A person is Disability payments are made for part of a week when one of the following Example 1: Sue who was a sales clerk retired on disability She now Example 2: Mary president of the XYZ Corporation retired on exclusion allowable for the period (see instructions) 2c fill in the total amount you received for all such weeks 2b Full year residents This is your disability income exclusion Fill in this amount on line 11 Generally no exclusion is left if line 5a is He or she cannot engage in any substantial gainful He or she cannot engage in any substantial gainful activity because If both husband and wife take the exclusion each must file a statement If the Department of Veterans Affairs (VA) certifies that you are If you meet these tests you can take the exclusion until the earliest of If you retired on disability after 1976 the physician s statement must If you retired on disability before January 1 1977 the physician s If you were married at the end of 2013 you must file a joint return instructions for line 1 or line 10 of Form 1NPR 8 Line 1 Fill in the amount of disability pay included in your federal Line 2c If you received disability pay for part of a week follow Line 5 Generally the most a person can exclude is $5 200 This Lines 2a and 2b You can exclude either your actual weekly of Form 1 If filing Form 1NPR see the instructions for line 1 or line 10 of Form 1NPR On January 1 2013 you had not yet reached the age when your Physician s Statement If you did not check the box on line 9 of Please fill in your name If you received disability payments This is your disability income exclusion Fill in here and see the smaller amount of either the amount you received or the highest Step 1 Divide $100 by the number of days a week you normally Step 2 Divide the disability pay you received by the number of days Step 3 Compare the Step 1 and Step 2 amounts The smaller amount Step 4 Multiply your daily rate by the number of days you received Step 5 Add your exclusion for that week to your exclusion for any were at least $100 Fill in the total 2a You did not in any year prior to 1984 choose to treat your disability You do not have to file another statement If you have not you must file a physician s statement (see instructions) You received disability income which is not otherwise exempt from You retired on disability and were permanently and totally disabled You were a Wisconsin resident when you received the disability You were not yet 65 when your 2013 tax year ended (If you were Your weekly pay is the following part of what (1) Permanently and totally disabled on January 1 1976 or January 1 1977 (1) YOURSELF (2) Permanently and totally disabled on the date he or she retired Date retired (2) SPOUSE (Applies Only to Disabled Retirees Under Age 65) 1 Fill in the amount of your disability pay (see instructions) 1 2 Excludable disability pay (see instructions): 2440W for this purpose However if you are filing federal Schedule R 3 Add amounts on line 2d columns (1) and (2) Fill in the total in column (2) 3 4 Fill in the smaller of line 1 (total of columns (1) and (2)) or line 3 4 5 Limit on exclusion (see instructions): 6 Subtract line 5c from line 4 and fill in on line 6 If line 5c is more than line 4 fill in 0 7 Part year residents Divide line 6 by the number of weeks you received disability payments 7 8 Part year residents Multiply line 7 by the number of weeks you were a Wisconsin resident and 9 If you filed a physician s statement for this disability in an earlier year check this box a year; or (b) can be expected to lead to death activity because of a physical or mental condition; and adjusted gross income less any amount that is otherwise exempt Administration or the commissioned corps of the Public Health and instructions for Physician s Statement ) and she works part time the work is done at her employer's convenience and your physician completed a Physician's Statement for use with that be able to exclude a portion of it from their taxable income Complete born on January 1 1949 you are considered to be age 65 at the born on January 1 1949 you are considered to be age 65 at the end box (2) considered gainful if it pays at a rate at or above the minimum wage Date you retired different work she babysits on ordinary terms for the minimum wage disability because of terminal illness On her doctor's advice she works Disability Income Exclusion disability pay in the short week The result is your exclusion for that disability pay or $100 a week whichever is less The following table Disability? Each month Multiply your pay by 12 and divide the result by 52 employer s Employer s name (also give payer s name if other than employer) employer sets her days and hours Although Mary s illness is terminal Enclose with Wisconsin end of 2013 ) Every 2 weeks Half exclusion exclusion for 2013 if you meet ALL these tests: exclusion goes down dollar for dollar by any amount over $15 000 expected to last continuously for at least a year; or (2) can be expected Form 1 or 1NPR form you may submit a copy of that statement instead of completing from Wisconsin tax (for example retirement payments received from from your local VA regional office General Instructions happens after the first day of the taxpayer s normal workweek: I 026 I certify that the person named above was (check only one box please see instructions below) income income as a pension instead of taking the exclusion Instructions for Statement is both substantial and gainful is not disability income is your daily rate Your exclusion for the week is based on it it covered in that week lasted or can be expected to last continuously for at least Legal name(s) shown on Form 1 or Form 1NPR more than those of a nonproductive make work nature An activity is Name of disabled person of 2013 ) of a physical or mental condition; and of the physician s statement VA Form 21 0172 must be signed by a on January 1 1976 or January 1 1977 on line 5a Other Divide your yearly pay by 52 other short weeks Fill in the total on line 2c part time as a manager and is paid more than the minimum wage Her Pay period you receive each pay period permanent and total disability You can use the statement on Schedule permanently and totally disabled when: permanently and totally disabled you can file VA Form 21 0172 instead person authorized by the VA to do so You can get VA Form 21 0172 Physician Physician s address Physician s name Physician s signature Physician s Statement of Permanent and Total Disability plan or pension plan instead of wages for the time you were absent from Please complete and return to the person named below program would have required you to retire required retirement age retired after December 31 1976 retired after December 31 1976 fill in retired before January 1 1977 retirement program would have required you to retire SCHEDULE 2440W Schedule 2440W you must have your physician complete a statement of See instructions on back Service) She cannot take the exclusion because she is engaged in an activity that She is considered engaged in a substantial gainful activity and cannot show that you were permanently and totally disabled when you retired shows how to figure your weekly disability pay Specific Instructions Spouse statement must show that you were permanently and totally disabled take the exclusion Taxpayer the commissioned corps of the National Oceanic and Atmospheric the disability income exclusion cannot be taken The examples below show substantial gainful activity In such cases the following dates: the physician's statement on Schedule 2440W the steps below the U S government that relate to service with the Coast Guard this schedule to determine the amount if any of your exclusion to lead to death total amount you were paid under your employer s accident and health Twice a month Multiply your pay by 24 and divide the result by 52 Weekly All What is Permanent and Total Disability? when you retired (See Instruction D What is Permanent and Total Wisconsin Department of Revenue Wisconsin tax work because of permanent and total disability However any payment worked before you retired works as a full time babysitter at the minimum wage Although Sue does you received from a plan that does not provide for disability retirement your retirement date in the space after Your social security number Yourself