(Form 1040) Credit for the Elderly or the Disabled

Attachment

 Attach to Form 1040.  See Instructions for Schedule R (Form 1040). Sequence No. 16

Your social security number

You may be able to take this credit and reduce your tax if by the end of 2001:

● You were age 65 or older or

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

If:

Due to your continued disabled condition, you were unable to engage in any substantial gainful activity

in 2001, check this box 

● If you checked this box, you do not have to get another statement for 2001.

OMB No. 1545-0074 Schedule R

For Paperwork Reduction Act Notice, see Form 1040 instructions.

Department of the Treasury

Internal Revenue Service

Name(s) shown on Form 1040

But you must also meet other tests. See page R-1.

In most cases, the IRS can figure the credit for you. See page R-1.

Check the Box for Your Filing Status and Age

Statement of Permanent and Total Disability (Complete only if you checked box 2, 4, 5, 6, or 9 above.)

1

Schedule R (Form 1040) 2001

2

If your filing status is:

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 total disability 4

5 Both spouses were under 65, and both retired on permanent and total

disability 5

Married filing a

joint return

6 One spouse was 65 or older, and the other spouse was under 65 and

retired on permanent and total disability 6

7 One spouse was 65 or older, and the other spouse was under 65 and

not retired on permanent and total disability 7

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

Married filing a 2001 8

separate return

9 You were under 65, you retired on permanent and total disability, and

you lived apart from your spouse for all of 2001 9

Did you check

box 1, 3, 7,

or 8?

Single,

Head of household, or 

Qualifying widow(er)

with dependent child

And by the end of 2001: Check only one box:

Cat. No. 11359K

Part I

Part II

● You were under age 65, you retired on permanent and total disability, and

you received taxable disability income.

Yes Skip Part II and complete Part III on back.

No Complete Parts II and III.





● If you did not check this box, have your physician complete the statement on page R-4. You must

keep the statement for your records.

(99)

2001
Schedule R (Form 1040) 2001 Page 2

Figure Your Credit

Box 1, 2, 4, or 7 $5,000

10 Enter:

10

● Box 6 in Part I, add $5,000 to the taxable disability income

of the spouse who was under age 65. Enter the total.

11

If you completed line 11, enter the smaller of line 10 or line 11; all others, enter the

amount from line 10

12

12

Enter the following pensions, annuities, or disability income

that you (and your spouse if filing a joint return) received in

2001:

13

a Nontaxable part of social security benefits and

13a Nontaxable part of railroad retirement benefits

treated as social security. See page R-3.

b Nontaxable veterans’ pensions and

13b Any other pension, annuity, or disability benefit that

is excluded from income under any other provision

of law. See page R-3.

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

c

13c

14

Enter the amount from Form 1040,

line 34

14

15

15

Subtract line 15 from line 14. If zero or

less, enter -0-

16

16

17 Enter one-half of line 16 17

18 Add lines 13c and 17 18

Subtract line 18 from line 12. If zero or less, stop; you cannot take the credit. Otherwise,

go to line 20

19

19

20

20 Multiply line 19 by 15% (.15). Enter the result here and on Form 1040, line 45. But if

this amount is more than the amount on Form 1040, line 42, minus any amount on line

43, or you are filing Form 2441, see page R-3 for the amount of credit you may take

Did you check

box 2, 4, 5, 6,

or 9 in Part I?

Box 3, 5, or 6 $7,500

Box 8 or 9 $3,750

If you checked (in Part I):

Box 1 or 2 $7,500

Enter:

Box 3, 4, 5, 6, or 7 $10,000

Box 8 or 9 $5,000

If you checked (in Part I):

Part III







● Box 2, 4, or 9 in Part I, enter your taxable disability income.

● Box 5 in Part I, add your taxable disability income to your

spouse’s taxable disability income. Enter the total.

For more details on what to include on line 11, see page R-3.

11

If you checked:



Yes You must complete line 11.

No Enter the amount from line 10

on line 12 and go to line 13.







Schedule R (Form 1040) 2001