District of Columbia Disability Income Exclusion

Disability Income Exclusion
Form D-2440
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Government of the
District of Columbia

2023 	D-2440 Disability
Income Exclusion

*232400110002*

Important: Print in CAPITAL letters using black ink.
Leave lines blank that do not apply.

OFFICIAL USE ONLY

Name as shown on Form D-40	

Vendor ID#0002

Taxpayer identification number (TIN)

Personal information
Date of your birth (MMDDYYYY)	

Date you retired (MMDDYYYY)	

Date of spouse’s/registered domestic
partner’s birth(MMDDYYYY)	
Date retired (MMDDYYYY)	

Name of your employer	

Payor, if other than employer		

Name of employer	

Payor, if other than employer		

Have you filed a physician’s certification for this disability in previous years?
Yes
No
If yes, do not file another certification. If no, you must file the physician’s certification provided below.

Income	

If married or registered domestic partners, use both columns.

Round cents to nearest dollar. If amount is zero, leave line blank.
You	

	 	

1	 $

	 	

2	 $	

.00	$
.00	$	

	 	

3	 $	

.00	$	

4	 Add the amounts for you and your spouse/registered domestic partner from Line 3.

4

$

Your spouse/registered domestic partner

.00
.00
.00

Total income

.00

Limitation on exclusion
5	 Federal adjusted gross income from Form D-40, Line 4.

$
$
$

.00
.00
.00
1 5 0 0 0 .00
.00
.00

Fill in if loss
			
5	

6	 Taxable social security income from Form D-40, Line 10.

6	

7	 Subtract Line 6 from Line 5.						

7	

8	 Amount used to reduce the excludable disability income.	
9	
$

9	 	
10	
Disability income payment excludable. Subtract Line 9 from Line 4.	

10	

$

Enter on D-40 Schedule I, Calculation B, Line 2 (see D-40 instructions). The exclusion may not exceed $5200 per disabled person.

Government of the
District of Columbia

2023 Physician’s Certification of Permanent and Total Disability

Name of disabled taxpayer	

Taxpayer identification number (TIN)		
MM

DD

I certify that the above taxpayer was permanently and totally disabled when the taxpayer retired. (Enter retirement date.)
Physician’s first name, middle initial, last name 	

Physician’s address (number and street)			

Suite number	

City		

State	

Physician’s phone number	

Physician’s signature	

Attach to Form D-40. See instructions on back.

Revised 08/2023

Zip Code + 4

Date	

YYYY

D-2440 PAGE 2

*232400120002*

Enter your last name
Enter your TIN
Government of the
District of Columbia

2023 Physician’s Certification of Permanent and Total Disability

Name of disabled taxpayer	

Taxpayer identification number (TIN)		
MM

DD

YYYY

I certify that the above taxpayer was permanently and totally disabled when the taxpayer retired. (Enter retirement date.)
Physician’s first name, middle initial, last name 	

Physician’s address (number and street)			

Suite number	

City		

State	

Physician’s phone number	

Zip Code + 4

Physician’s signature	

Date	

What is the purpose of Form D-2440?
Form D-2440 is used to determine the amount of disability income
you may exclude from the federal adjusted gross income you report
on DC Form D-40. Enter the amount from Line 10 of this form on
Line 2 of Calculation B of Schedule I. The maximum annual exclusion per disabled person is $5,200.

Line 2 If you received disability payments for part of a week,
follow the example below to determine the exclusion for that
portion:

Who may file a Form D-2440?
You must meet all of the following requirements:

Example: $100 divided by 5 days (number of days in typical work
week) = $20. $20 x 3 (number of days you were paid for partial
week) = $60. Add this amount to the total amount you were paid
for the full weeks.

• If you are married or registered domestic partners, you are filing
a joint return;
• You received disability payments during 2023;
• You were under the age of 65 on December 31, 2023;
• You retired on disability and were permanently and totally disabled
when you retired;
• On January 1, 2023, you had not reached the age required to
retire under your employer’s retirement program; and

Divide $100 by the number of days in a week you normally worked
before you retired and multiply the result by the number of days you
were paid for the partial week.

Line 5 Federal adjusted gross income from Form D-40, Line
4. If the amount on this line is minus, fill in the oval.
Line 8 Amount used to reduce disability income
$15,000 is the amount DC uses to reduce the disability income
you can exclude.

• You have not notified the Office of Tax and Revenue that you have
chosen to treat the disability income as a pension.

Line 10 Disability income exclusion
This is the amount you may use to reduce your DC taxable income.
$5,200 is the maximum annual amount per disabled person that
may be excluded.

Personal information

Physician’s certification

If you are filing a joint return, please provide the information requested for you and your spouse/registered domestic partner, even
if your spouse/registered domestic partner is not disabled and is not
claiming a disability exclusion.

To claim an exclusion, your physician must certify that you are, according to the definition below, permanently disabled. If both you and your
spouse/registered domestic partner are claiming the exclusion, each
must file a certification. You do not have to file another certification
if you have filed one in a previous year. Attach the certification(s) to
your Form D-40.

Income and Limitation on Exclusion
Line 1 Total amount of disability payments received in 2023.
Enter the total amount of disability payments you received in
2023. Do not include any lump-sum payment received for accrued
annual leave when you retired on disability. (The annual leave
payment is included in your gross income for the year of receipt.)
Payments from a retirement plan or profit-sharing plan that does not
have a provision for disability retirement do not qualify for
the exclusion.

Revised 08/2023

Instruction for the Physician
Date taxpayer retired
Please certify that the taxpayer ceased active employment because
of his or her permanent disability and retired on the date that he
or she became disabled.
Definition of permanent and total disability
Permanent and total disability means that the taxpayer is unable
to engage in any substantial gainful activity because of a physical
or mental condition and this condition has lasted continuously for
at least a year, will last continuously for at least a year, or is fatal.