Indiana Indiana Disability Retirement Deduction

Indiana Disability Retirement Deduction
Form IT-2440
Indiana Disability Retirement Deduction

Schedule

IT-2440

Attach to Form IT-40 or Form IT-40PNR.

State Form 46003
(R17 / 9-23)

Your Social
Security Number
Your first name

Initial

Spouse’s Social
Security Number
Last name

If filing a joint return, spouse’s first name

Initial

Last name

►Enter the date you and/or your spouse retired.
Yourself

	

MM	

DD	

►Enter the employer’s name below or give payer’s name, if other than employer.

Spouse

YYYY	

MM	

DD	

Your Employer’s or Payer’s Name

YYYY

►Your Daytime Telephone Number

Note

2023

Enclosure
Sequence No. 15

Spouse’s Employer’s or Payer’s Name

• To claim this deduction, you must complete lines 1 through 6 and enclose this schedule with your Indiana return.
• Joint return filers use lines 1A and 3A for you and/or lines 1B and 3B for your spouse’s information.

Column A: Yours
1.	 Enter total disability payments received during the year_______ 	 1A	.00	

Column B: Spouse’s
1B	.00

2.	 Add lines 1A and 1B______________________________________________________________ 	 2	.00
3.	 Excess of disability payments over $100 per week
(see line 3 instructions, Table A and the Worksheet)__________ 	 3A	.00	 3B	.00
4.	 Excess of federal adjusted gross income over $15,000

(over $7,500 if married filing separately - see instructions)________________________________ 	 4	.00

5.	 Add lines 3A, 3B, and 4___________________________________________________________ 	 5	.00
6.	 Line 2 minus line 5 (if less than zero, enter zero). This is your disability retirement deduction.
Enter here and on Form IT-40, Schedule 2, under line 11, or on Form IT-40PNR, Schedule C,
under line 11____________________________________________________________________ 	6	.00

Physician’s Statement of Permanent and Total Disability
Completed statement must be signed and dated by the physician.

Name of Disabled Individual	
First Name

	

Date you Retired
Initial

Last Name
M M	

Physician Information
First Name

Initial

Last Name

Address (Street Address, City, State and ZIP Code)

►	 I certify that the taxpayer named above is permanently and totally disabled (see instructions).
	

Physician’s Signature						

Date

	

____________________________________________________________________________________

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D D	

YYYY

Line-by-Line Instructions
Do You Qualify for the Deduction?

Table A - How to figure your weekly pay:

You may qualify for the deduction if you meet both of the
following requirements:
y	 You retired on disability before December 31 of the tax
year for which you are claiming the deduction; and
y	 You were permanently and totally disabled when you
retired.
If you meet these requirements, you may be eligible to subtract
up to $5,200 a year of your disability payments from your gross
income. The amount you subtract is limited to the amount of
disability pay you actually received or $100 a week, whichever
is less, and may have to be reduced by part of your federal
adjusted gross income.
Your spouse may also be eligible to subtract up to $5,200 of
disability payments if you file a joint return and your spouse
meets all the above requirements.
Note: In no case may the total deduction be more than
$10,400 on a joint return.

General Instructions
Enter your name(s), Social Security number(s) and, if
applicable, the date you retired.
On a joint return, if both spouses qualify for the disability
retirement deduction, two Physician’s Statements must be
attached. Use only one Schedule IT-2440 to calculate the
deduction.
Line 1 - Enter the amount received during the taxable year
through an accident and health plan for personal injuries or
sickness. Use line 1A for yourself and line 1B for your spouse.
Line 3 - The amount you can deduct is limited to the disability
income you received each week or $100 per week, whichever
is less.
If you did not receive your disability pay each week, you will
have to figure your weekly pay (see Table A).

If you were paid:	

Figure your weekly pay by:

Every 2 weeks.............. Divide your gross pay by 2
Twice a month.............. Multiply your gross pay by 24 and
	
divide the result by 52
Once a month............... Multiply your gross pay by 12 and
	
divide the result by 52
Any other way............... Divide your gross yearly pay by 52
Note: If you did not receive disability income for the whole
year, use the actual amount of weeks/months.
Example: Jim received disability income of $130 a week for
six weeks. He should complete the worksheet below, entering
the $130 amount on line a.
Worksheet - How to figure the excess over $100 for full
weeks:
a.	 Weekly disability pay received.......... a ___________
b.	 Maximum weekly deduction............. b - 100
c.	 Subtract line b from line a (If line b
is larger than line a, enter 0)............. c ___________
d.	 Number of full weeks for which you
received disability pay...................... d ___________
e.	 Multiply the amount on line c by line
d. Enter here and on line 3A or 3B
on the front of this schedule............. e ___________
Line 4 - The deduction is further reduced by the excess
of the federal adjusted gross income (AGI) over $15,000
($7,500 if married filing separately).
a.	 Federal AGI (from IT-40 line 1 or from
IT-40PNR Schedule A, line 36A)...... a	 ___________
b.	 Income limit (see above).................. b	 -	
c.	 Subtract b from a (if b is larger
than a, enter 0). Enter here and on
line 4 on the front of this schedule.... c	 ___________

Instructions for Physician’s Statement

A person is permanently and totally disabled when:
y	 He or she cannot engage in any substantial gainful
activity because of a physical or mental condition; and
y	 A physician determines that the disability
(a)	has lasted or can be expected to last continuously
for at least a year, or
(b)	can be expected to result in death.		

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