U.S. Individual Income Tax Return Forms

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2025

Instructions for Schedule R
(Form 1040)
Credit for the Elderly or the Disabled
Section references are to the Internal Revenue Code unless
otherwise noted.

Future Developments
For the latest information about developments related to
Schedule R (Form 1040) and its instructions, such as legislation
enacted after they were published, go to IRS.gov/ScheduleR.

We have discontinued Pub. 524, Credit for the Elderly or the
Disabled; the last revision was for 2023. All the pertinent
information from Pub. 524 has been incorporated into the
Instructions for Schedule R. Prior revisions of Pub. 524 will
remain available at IRS.gov/Pub524.

General Instructions
Purpose of Form

Use Schedule R (Form 1040) to figure the credit for the elderly or
the disabled.

Who Can Take the Credit

You can take the credit for the elderly or the disabled if you meet
both of the following requirements.
• You are a qualified individual.
• Your income isn’t more than certain limits.
You can use Figure A and Table 1 as guides to see if you are
eligible for the credit. Use Figure A first to see if you are a
qualified individual. If you are, then go to Table 1 to make sure
your income isn’t too high to take the credit.

Qualified Individual

You are a qualified individual for this credit if you are a U.S.
citizen or resident alien (or you elect to be treated as a resident
alien) and either of the following applies.
1. You were age 65 or older at the end of 2025.
2. You were under age 65 (discussed later) at the end of
2025 and all three of the following statements are true.
a. You retired on permanent and total disability. (See
Permanent and Total Disability, later).
b. You receive taxable disability income for 2025.
c. On January 1, 2025, you had not reached mandatory
retirement age (defined later under Disability Income).

Age 65

You are considered age 65 on the day before your 65th birthday.
As a result, if you were born on January 1, 1961, you are
considered to be age 65 at the end of 2025.
Death of taxpayer. If you are preparing a return for someone
who died in 2025, consider the taxpayer to be age 65 at the end
of 2025 if they were age 65 or older on the day before their
death. For example, if the taxpayer was born on February 14,
Sep 30, 2025

U.S. Citizen or Resident Alien

You must be a U.S. citizen or resident alien (or be treated as a
resident alien) to take the credit. Generally, you can’t take the
credit if you were a nonresident alien at any time during the tax
year.
Exceptions. If you are a nonresident alien, you may be able to
take the credit if your spouse is a U.S. citizen or resident at the
end of the tax year, you file a joint return, and you and your
spouse elect to treat you as a U.S. resident for the entire year.
This choice remains in effect in subsequent years until
terminated. You and your spouse can also choose to file as U.S.
residents for the entire year if both of you are U.S. citizens or
residents at the end of the year and either (or both) of you were a
nonresident at the beginning of the year (the dual-status
spouse(s)). You can only make this choice for 1 year, and it does
not apply to any future years.
For information on these choices, see the Instructions for
Form 1040 and chapter 1 of Pub. 519.
You can take the credit only if you file Form 1040 or

TIP 1040-SR. You can’t take the credit if you file Form
1040-NR.

Married Persons

Generally, if you are married at the end of the tax year, you and
your spouse must file a joint return to take the credit. However, if
you and your spouse lived apart, you might be eligible for the
credit.

Married persons filing separate returns. If your filing status is
married filing separately and you lived apart from your spouse at
all times during 2025, you can claim the credit. However, if you
lived with your spouse at any time during 2025, you can’t take
the credit (unless you and your spouse choose to file jointly
instead).

Head of Household

You can file as head of household and qualify to take the credit,
even if your spouse lived with you during the first 6 months of the
year, if you meet all the following tests.
1. You file a separate return.
2. You paid more than half the cost of keeping up your home
during the tax year.
3. Your spouse didn’t live in your home at any time during
the last 6 months of the tax year and the absence wasn’t
temporary. See Temporary absences under Head of Household
in Pub. 501.
4. Your home was the main home of your child, your
stepchild, or an eligible foster child for more than half the year.
An eligible foster child is a child placed with you by an authorized

Instructions for Schedule R (Form 1040) (2025) Catalog Number 11357O
Department of the Treasury Internal Revenue Service www.irs.gov

DRAFT

DRAFT

Reminder

1960, and died on February 13, 2025, the taxpayer is considered
age 65 at the time of death. However, if the taxpayer died on
February 12, 2025, the taxpayer isn’t considered age 65 at the
time of death or at the end of 2025.

TREASURY/IRS AND OMB USE ONLY DRAFT
placement agency or by judgment, decree, or other order of any
court of competent jurisdiction.
5. The child is your dependent, or would be your dependent
except that the noncustodial parent is entitled to claim the child
as their dependent under the special rule for children of divorced
or separated parents. See Children of divorced or separated
parents (or parents who live apart) in Pub. 501.
For more information, see the Instructions for Form 1040 or Pub.
501.

Under Age 65

If you are under age 65 at the end of 2025, you can qualify for
the credit only if you are retired on permanent and total disability
(discussed next), have taxable disability income (discussed later
under Disability Income), and as of January 1, 2025, had not
reached Mandatory retirement age. You are retired on
permanent and total disability if:
• You were permanently and totally disabled when you retired,
and
• You retired on disability before the close of the tax year.

If you retired on disability before 1977, and weren’t
permanently and totally disabled at the time, you can qualify for
the credit if you were permanently and totally disabled on
January 1, 1976, or January 1, 1977.
You are considered to be under age 65 at the end of

TIP 2025 if you were born after January 1, 1961.

Permanent and Total Disability
You are permanently and totally disabled if both 1 and 2 below
apply.
1. You can’t engage in any substantial gainful activity
because of a physical or mental condition.
2. A qualified physician determines that the condition has
lasted or can be expected to last continuously for at least a year
or can be expected to result in death. See Physician’s
Statement, later.
Substantial gainful activity. Substantial gainful activity is the
performance of significant duties over a reasonable period of
time while working for pay or profit, or in work generally done for
pay or profit. Full-time work (or part-time work done at your
employer’s convenience) in a competitive work situation for at
least the minimum wage conclusively shows that you are able to
engage in substantial gainful activity.
Note: Information on minimum wage rates is available at
DOL.gov/general/topic/wages/minimumwage.
Substantial gainful activity isn’t work you do to take care of
yourself or your home. It isn’t unpaid work on hobbies,
institutional therapy or training, school attendance, clubs, social
programs, and similar activities. However, the nature of the work
you perform may show that you are able to engage in substantial
gainful activity.
The fact that you haven’t worked or have been unemployed
for some time isn’t, of itself, conclusive evidence that you can’t
engage in substantial gainful activity.
The following examples illustrate the tests of substantial
gainful activity.
Example 1. Alex, a sales clerk, is retired on disability. Alex is
53 years old and now works as a full-time babysitter for the
minimum wage. Although different work is performed, Alex is
2

Example 2. Blake, a bookkeeper, is retired on disability.
Blake is 59 years old and now drives a truck for a charitable
organization. Blake decides what hours to work and isn’t paid.
Duties of this nature are generally performed for pay or profit.
Blake works 10 hours some weeks, and some weeks 40 hours.
Over the year, Blake averages 20 hours a week. The kind of work
and the average hours per week conclusively show that Blake is
able to engage in substantial gainful activity. This is true even
though Blake isn’t paid and sets the hours to work. Blake can’t
take the credit.
Example 3. Cameron, who retired on disability, took a job
with a former employer on a trial basis. The purpose of the job
was to see if Cameron could do the work. The trial period lasted
for 6 months during which Cameron was paid the minimum
wage. Because of Cameron’s disability, only light duties of a
nonproductive “make-work” nature were assigned. Unless the
activity is both substantial and gainful, Cameron isn’t engaged in
a substantial and gainful activity. The activity was gainful
because Cameron was paid at least the minimum wage.
However, the activity wasn’t substantial because Cameron’s
duties were nonproductive. These facts don’t, by themselves,
show that Cameron is able to engage in substantial gainful
activity.
Example 4. Dean, who retired on disability from a job as a
bookkeeper, lives with a relative who manages several motel
units. Dean is 56 years old and helps the relative for 1 or 2 hours
a day by performing duties such as washing dishes, answering
phones, registering guests, and bookkeeping. Dean can select
the time of day when Dean feels the most fit to work. Work of this
nature, performed off and on during the day at Dean’s
convenience, isn’t activity of a substantial and gainful nature
even if Dean is paid for the work. The performance of these
duties doesn’t, of itself, show that Dean is able to engage in
substantial gainful activity.
Sheltered employment. Certain work offered at qualified
locations to physically or mentally impaired persons is
considered sheltered employment. These qualified locations
include work centers that are certified by the Department of
Labor (formerly referred to as “sheltered workshops”), hospitals
and similar institutions, homebound programs, and Department
of Veterans Affairs (VA) sponsored homes.
Compared to commercial employment, pay is lower for
sheltered employment. Therefore, one usually doesn’t look for
sheltered employment if they can get other employment. The
fact that one has accepted sheltered employment isn’t proof of
the person’s ability to engage in substantial gainful activity.

Disability Income
If you are under age 65, you must also have taxable disability
income to qualify for the credit. Disability income must meet both
of the following requirements.
1. It must be paid under your employer’s accident or health
plan or pension plan.
2. It must be included in your income as wages (or payments
instead of wages) for the time you are absent from work because
of permanent and total disability.
Payments that aren’t disability income. Any payment you
receive from a plan that doesn’t provide for disability retirement
isn’t disability income. Any lump-sum payment for accrued
annual leave that you receive when you retire on disability is a
salary payment and isn’t disability income.

DRAFT

DRAFT

Even if you don’t retire formally, you may be considered
retired on disability when you have stopped working because of
your disability.

able to do the duties of the new job in a full-time competitive
work situation for the minimum wage. The credit can’t be taken
because Alex is able to engage in substantial gainful activity.

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Mandatory retirement age. For purposes of the credit for the
elderly or the disabled, disability income doesn’t include
amounts you receive after you reach mandatory retirement age.
Mandatory retirement age is the age set by your employer at
which you would have had to retire, had you not become
disabled.

Income Limits

To determine if you can claim the credit, you must consider two
income limits. The first limit is the amount of your adjusted gross
income (AGI). The second limit is the amount of nontaxable
social security and other nontaxable pensions, annuities, or
disability income you received. The limits are shown in Table 1.
If your AGI and your nontaxable pensions, annuities, or
disability income are less than the income limits, you may be
able to claim the credit.

!

CAUTION

If your AGI or your nontaxable pensions, annuities, or
disability income are equal to or more than the income
limits, you can’t take the credit.

Want the IRS To Figure Your Credit?

If you can take the credit and you want the IRS to figure the
credit for you, check the appropriate box in Part I of Schedule R
and fill in Part II and lines 11 and 13 of Part III, if they apply to
you. Then, on Schedule 3 (Form 1040), line 6d, enter “CFE” on
the line next to that box. Attach Schedule R to your return.

Specific Instructions
Part I—Check the Box for Your Filing
Status and Age

Check the box in Part I of Schedule R that applies to you. Only
check one box in Part I. If you check box 2, 4, 5, 6, or 9 in Part I,
also complete Part II of Schedule R.

Part II—Statement of Permanent and
Total Disability

If you checked box 2, 4, 5, 6, or 9 in Part I and you didn’t file a
physician’s statement for 1983 or an earlier year, or you filed or
got a statement for tax years after 1983 and your physician
signed on line A of the statement, you must have your physician
complete a statement certifying that:
• You were permanently and totally disabled on the date you
retired; or
• If you retired before 1977, you were permanently and totally
disabled on January 1, 1976, or January 1, 1977.
You don’t have to file this statement with your tax return, but
you must keep it for your records. You can use the Physician’s
Statement later in these instructions for this purpose. Your
physician should show on the statement if the disability has
lasted or can be expected to last continuously for at least a year,
or if there is no reasonable probability that the disabled condition
will ever improve. If you file a joint return and you checked box 5
in Part I, you and your spouse must each get a statement.

If you checked box 4, 5, or 6 in Part I, enter in the space
above the box on line 2 in Part II the first name(s) of the
spouse(s) for whom the box is checked.
If the Department of Veterans Affairs (VA) certifies that you
are permanently and totally disabled, you can use VA Form
21-0172 instead of the physician’s statement. VA Form 21-0172
must be signed by a person authorized by the VA to do so. You
can get this form from your local VA regional office.

Part III—Figure Your Credit

To figure your credit, you must first determine your initial amount
using lines 10 through 12. Your initial amount depends on your
filing status and, if you are under age 65, the amount of your
taxable disability income. The initial amount for qualified
individuals under age 65 may be less than the amount shown for
a filing status.

Initial Amounts for Persons Under Age 65

If you are a qualified individual under age 65, your initial amount
can’t be more than your taxable disability income. Your initial
amount will be the lesser of the initial amount shown on line 10
for your filing status or your taxable disability income figured on
line 11. The smaller of these two amounts will be entered on
line 12.
Special rules for joint returns. If you file a joint return and
both you and your spouse are qualified individuals, the initial
amount you report for yourself and your spouse on Schedule R
will depend on whether only one of you is (or both of you are)
under age 65.
If only one of you is under age 65, your initial amount can’t be
more than $5,000 plus the taxable disability income of the
spouse who is under age 65.
If both you and your spouse are under age 65, the initial
amount for you and your spouse can’t be more than your
combined taxable disability income.

Line 10

Use the following table to complete line 10.
IF you checked . . .

THEN enter on line 10 . . .

box 1, 2, 4, or 7

$5,000

box 3, 5, or 6

$7,500

box 8 or 9

$3,750

Line 11

If you or your spouse were under age 65, you must figure the
amount of your taxable disability income for line 11.
If you checked box 2, 4, 5, 6, or 9 in Part I, use the following
table to complete line 11.

If you filed a physician’s statement for 1983 or an earlier year,
or you filed or got a statement for tax years after 1983 and your
physician signed on line B of the statement, you don’t have to get
another statement for 2025. However, you must check the box
on line 2 in Part II to certify all three of the following.
1. You filed or got a physician’s statement in an earlier year.
3

DRAFT

DRAFT

You can figure the credit yourself or the IRS will figure it for you. If
you want to figure the credit yourself, skip this section and see
Part I, later.

2. You were permanently and totally disabled during 2025.
3. You were unable to engage in any substantial gainful
activity during 2025 because of your physical or mental
condition.

TREASURY/IRS AND OMB USE ONLY DRAFT
IF you checked . . .

THEN enter on line 11 . . .

box 6

the total of $5,000 plus the disability income
you reported on your tax return for the
spouse who was under age 65.

box 2, 4, or 9

the total amount of disability income you
reported on your tax return.

box 5

the total amount of disability income you
reported on your tax return for both you and
your spouse.

Example 2. You checked box 2 in Part I and entered $5,000
on line 10. You received $3,000 of taxable disability income and
will report the income on Form 1040 or 1040-SR. On line 11, you
will enter $3,000. You will enter $3,000 on line 12 (the smaller of
line 10 or line 11). The largest amount that can be used to figure
the credit is $3,000.

Lines 13a and 13b

The amount on which you figured your credit can be reduced if
you received certain types of nontaxable pensions, annuities, or
disability income. Use lines 13a through 13c to figure the
nontaxable portion.
Worksheets are provided in the Instructions for Form

TIP 1040 to help you determine if any of your social security
taxable.

benefits (or equivalent railroad retirement benefits) are

Line 13a
Enter any social security benefits (before deduction of Medicare
premiums) you (and your spouse if filing jointly) received for
2025 that aren’t taxable.

Line 21
Credit Limit Worksheet

Also, enter any tier 1 railroad retirement benefits treated as
social security that aren’t 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 1040 or
1040-SR, line 6a and line 6b.
If your social security or equivalent railroad retirement
benefits are reduced because of workers’ compensation
CAUTION benefits, treat the workers’ compensation benefits as
social security benefits when completing Schedule R (Form
1040), line 13a.

!

Line 13b
Enter the total of the following types of income that you (and your
spouse if filing jointly) received for 2025.
• Veterans’ pensions (but not military disability pensions).
• Any other pension, annuity, or disability benefit that is
excluded from income under any provision of federal law other
than the Internal Revenue Code. Don’t include amounts that are
treated as a return of your cost of a pension or annuity.
Don’t 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, don’t include a disability annuity payable under
section 808 of the Foreign Service Act of 1980.
Be sure to take into account all of the nontaxable
amounts you receive. These amounts are verified by the
CAUTION IRS through information supplied by other government
agencies.

!

Excess Adjusted Gross Income

The amount on which you figure your credit can also be reduced
if your adjusted gross income is over a certain amount. This will
be figured on lines 14 through 17.

Keep for Your Records

The amount of credit you can claim is generally limited to the amount of your tax. Use the Credit Limit Worksheet to
determine if your credit is limited.

1. Enter the amount from Form 1040 or 1040-SR, line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Enter the amount from Schedule 3 (Form 1040), lines 1, 2, and 6l . . . . . . . . . . . . . . . . .
3. Subtract line 2 from line 1. Enter this amount on Schedule R (Form 1040), line 21. If
zero or less, stop; you can’t take this credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

1.
2.
3.

DRAFT

DRAFT

Example 1. You are 63 years old and retired on permanent
and total disability in 2025. You are filing jointly with your spouse,
who was age 67 in 2025. You check box 6 in Part I and enter
$7,500 on line 10. You received $4,000 of taxable disability
income and will report the income on Form 1040 or 1040-SR. On
line 11, you will enter $9,000 ($5,000 plus the $4,000 of disability
income you will report on Form 1040 or 1040-SR). You will enter
$7,500 on line 12 (the smaller of line 10 or line 11). The largest
amount that can be used to figure the credit is $7,500.

Don’t include a lump-sum death benefit payment you may
receive as a surviving spouse, or a surviving child’s insurance
benefit payments you may receive as a guardian.

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Examples

The following examples illustrate the credit for the elderly or the
disabled.
Example 1. Jesse is 58 years old, single, and files Form
1040. In 2023, Jesse retired on permanent and total disability,
and is still permanently and totally disabled. Jesse got the
required physician’s statement in 2023 and kept it with personal
tax records. The physician signed on line B of the statement.
This year, Jesse checks the box in Schedule R, Part II. Jesse
doesn’t need to get another statement for 2025.
Jesse received the following income for the year.
Nontaxable social security . . . . . .
Interest (taxable) . . . . . . . . . . . .
Taxable disability pension . . . . . .
Adjusted gross income (Form 1040,
line 11a) . . . . . . . . . . . . . . . . .

. . . . . . .

$700
$100
$15,900

. . . . . . .

$16,000

. . . . . . .
. . . . . . .

1.

Initial amount based on filing status (line 10) . . .

$5,000

2.

Taxable disability pension (line 11) . . . . . . . . .

$15,900

3.

Initial amount (smaller of line 10 or line 11)
(line 12) . . . . . . . . . . . . . . . . . . . . . . . . .

$5,000

4.

Nontaxable social security
benefits (line 13c) . . . . . . . . . . . . .

$700

5.

Excess adjusted gross income (line 17)
($16,000 − $7,500) ÷ 2 . . . . . . . . . .

$4,250

6.

Add lines 4 and 5 (line 18) . . . . . . . . . . . . . .

$4,950

7.

Subtract line 6 from line 3 (line 19)
(If zero or less, stop; you can’t take the
credit.) . . . . . . . . . . . . . . . . . . . . . . . . . .

$50

8.

Multiply line 7 by 15% (0.15) (line 20)

. . . . . . .

$8

9.

Enter the amount from the
Credit Limit Worksheet, earlier (line 21) . . . . . .

$26

10. Credit (Enter the smaller of
line 20 or line 21.) (line 22) . . . . . . . . . . . . . .

$8

Riley and Parker made that determination on Schedule R as
follows. Line references (shown in parentheses) are to
Schedule R.
1.

Initial amount based on filing status (line 10) . . .

$7,500

2.

Taxable disability pension (line 11) . . . . . . . . .

$13,000

3.

Initial amount (smaller of line 10 or line 11)
(line 12) . . . . . . . . . . . . . . . . . . . . . . . . .

$7,500

4.

Nontaxable social security
benefits (line 13c) . . . . . . . . . . . . .

$2,000

5.

Excess adjusted gross income (line 17)
($40,000 − $10,000) ÷ 2 . . . . . . . . .

$15,000

6.

Add lines 4 and 5 (line 18) . . . . . . . . . . . . . .

$17,000

7.

Subtract line 6 from line 3 (line 19)
(If zero or less, stop; you can’t take the
credit.) . . . . . . . . . . . . . . . . . . . . . . . . . .

($9,500)

8.

Multiply line 7 by 15% (0.15) (line 20)

. . . . . . .

N/A

9.

Enter the amount from the
Credit Limit Worksheet, earlier (line 21) . . . . . .

N/A

10. Credit (Enter the smaller of
line 20 or line 21.) (line 22) . . . . . . . . . . . . . .

N/A

The amount on line 3, $7,500, is less than the amount on
line 6, $17,000. Subtracting $17,000 from $7,500 produces a
negative amount. As a result, Riley and Parker may not claim the
credit.

Jesse can claim the credit. He enters $8 on Schedule R,
line 22, and Schedule 3 (Form 1040), line 6d, and attaches a
completed Schedule R to his tax return.
Example 2. Riley, age 53, is married to Parker, age 49. Riley
had a stroke 3 years ago and retired on permanent and total
disability. Riley is still permanently and totally disabled because
of the stroke. In November, Parker was injured in an accident at
work and retired on permanent and total disability.
Riley received nontaxable social security disability benefits of
$2,000 during the year and a taxable disability pension of
$10,000. Parker earned $27,000 from a job and received a
taxable disability pension of $3,000. Their joint return on Form
1040, line 11a, shows adjusted gross income of $40,000
($10,000 + $27,000 + $3,000). Their filing status is married filing
jointly. They don’t itemize deductions. They don’t have any
amounts that would increase their standard deduction.
Parker’s doctor completed the physician’s statement in the
Instructions for Schedule R. Parker isn’t required to include the
statement with the tax return, but Parker must keep it for their
records.

5

DRAFT

DRAFT

The adjusted gross income is the total of Jesse’s taxable
interest and taxable disability pension ($100 + $15,900). Jesse
figures the credit on Schedule R as follows. Line references
(shown in parentheses) are to Schedule R.

Riley got a physician’s statement for the year Riley had the
stroke. Riley’s doctor had signed on line B of that physician’s
statement to certify that Riley had a permanent and total
disability. Riley has kept the physician’s statement with their tax
records. Riley checks the box on Schedule R, Part II, and will
write “Riley” in the space above the box on line 2.
Riley and Parker use Schedule R to figure their credit for the
elderly or disabled. They are ineligible for the credit because
their initial amount is less than zero. They can’t take the credit
because their nontaxable social security plus their excess
adjusted gross income is more than their initial amount.

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Figure A. Are You a Qualified Individual?
Did you live with your
spouse at any time
during the tax year?1
Yes
Are you filing a joint
return with your spouse?

Yes

Were you married at the end of the tax year?

No

No

Yes
No

Are you a U.S. citizen or resident alien?2
Yes

No
You aren’t a qualified
individual and can’t
take the credit for
the elderly or the
disabled.

Start Here

Were you 65 or older at the end of
the tax year?

Yes

No
No

You are a qualified
individual and may
be able to take the
credit for the elderly
or the disabled
unless your income
exceeds the limits in
Table 1.

Are you retired on permanent and
total disability?
Yes

Yes Did you reach mandatory retirement
age before the tax year? 3

DRAFT

No

Did you receive taxable disability
benefits during the tax year?

DRAFT

No
Yes

However, you may be able to claim this credit even if you lived with your spouse during the first 6 months of the tax year, as long as you qualify
to file as head of household. You qualify to file as head of household if you are considered unmarried and meet certain other conditions. See
Publication 501 for more information.
2
If you were a nonresident alien at any time during the tax year and were married to a U.S. citizen or resident alien at the end of the tax year,
see U.S. Citizen or Resident Alien under Qualified Individual. If you and your spouse choose to treat you as a U.S. resident alien, answer “Yes”
to this question.

1

3

Mandatory retirement age is the age set by your employer at which you would have been required to retire, had you not become disabled.

Table 1. Income Limits
THEN, you generally CAN’T take the credit if...

IF your filing status is...

The amount on Form 1040 or 1040-SR,
line 11a* is...

OR the total of your nontaxable social security
and other nontaxable pension(s), annuities, or
disability income is equal to or more than...

single, head of household, or
qualifying surviving spouse

$17,500 or more

$5,000

married filing jointly and only one
spouse is a qualifying individual

$20,000 or more

$5,000

married filing jointly and both
spouses are qualifying individuals

$25,000 or more

$7,500

married filing separately and you
lived apart from your spouse for all
of 2025

$12,500 or more

$3,750

* AGI is the amount on Form 1040 or 1040-SR, line 11a.

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TREASURY/IRS AND OMB USE ONLY DRAFT

Instructions for Physician’s Statement
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. They can’t 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.

DRAFT

Physician

Physician’s Statement
I certify that

DRAFT

Taxpayer

Keep for Your Records

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 they retired. If retired after 1976, enter the date retired:
Physician: Sign your name on either line A or B below.
A The disability has lasted or can be expected
to last continuously for at least a year . . . . . . . .
B There is no reasonable probability that the
disabled condition will ever improve . . . . . . . . .
Physician’s name

Physician’s signature

Date

Physician’s signature

Date

Physician’s address

7