Montana Disability Income Exemption (OBSOLETE)

Disability Income Exemption (OBSOLETE)
Form DS-1
Clear Form
MONTANA
DS-1
Rev 04 16

2016 Disability Income Exclusion
15-30-2110(10), MCA

Social Security Numbers
First Name and Initial

Last Name

Spouse’s First Name and Initial

Last Name

-

-

-

-

Column A (for
single, joint,
separate,
or head of
household)

Column B (for
spouse when
married filing
separately on
the same form)

Complete lines 1 through 3 for retirement disability benefits that you received for a full week.
1. Multiply the amount of the retirement disability benefits that you received per week
by the number of weeks you received these benefits and enter the result............ 1.
2. Multiply $100 by the number of weeks you received retirement disability benefits
and enter the result, but not more than $5,200...................................................... 2.
3. Enter the smaller of line 1 or line 2......................................................................... 3.
Complete lines 4 through 6 for retirement disability benefits that you received for a portion of a week.
4. Enter the amount of the retirement disability benefits that you received for a portion
of a week................................................................................................................4.
5. Multiply $20 by the number of work days you received retirement disability benefits
and enter the result................................................................................................5.
6. Enter the smaller of line 4 or line 5......................................................................... 6.
7. Add line 3 and line 6 and enter the result............................................................... 7.
8. Add the amounts on line 7, columns A and B, and enter the result.................................................. 8.
9. Enter your Montana adjusted gross income before your disability income exclusion
(see instructions)....................................................................................................9.
10. Add the amounts on line 9, columns A and B, and enter the result................................................ 10.
11. Your income limitation amount is entered here.............................................................................. 11.

$15,000

12. Subtract line 11 from line 10 and enter the result, but not less than zero....................................... 12.
13. Subtract line 12 from line 8 and enter the result, but not less than zero. This is your partial
retirement disability income exclusion. Enter this amount on Form 2, Schedule II, line 13...... 13.

If you file your Montana tax return electronically, you do not need to mail this form to us unless we ask you for a copy. When you file electronically, you
represent that you have retained the required documents in your tax records and will provide them upon the department’s request.

Form DS-1 Instructions
How can I determine if I am eligible for the retirement
disability income exclusion?
You are eligible to take this exclusion if you:
•	 are a Montana resident,
•	 are under the age of 65,
•	 are permanently and totally disabled, and
•	 have not chosen to treat this retirement disability
income as a pension or annuity.
Permanently and Totally Disabled means that you are
unable to engage in any substantial gainful activity by
reason of any medically determined physical or mental
impairment lasting or expected to last at least 12 months.
What income qualifies for the retirement disability
income exclusion?
The only income used to determine your exclusion is
income reportable on federal Form 1099-R with a Box 7
distribution code of 3.
How do I determine my Montana adjusted gross
income before the disability income exclusion?
The amount recorded on line 9 is the total of your federal
adjusted gross income (Form 2, line 38) plus the total
amount of your Montana additions to federal adjusted gross
income (Form 2, line 39) minus any Montana subtractions
to federal adjusted gross income (Form 2, line 40). To
determine the Montana subtractions before the disability
income exclusion, add the entries on Form 2, Schedule
II, except line 13. If you are married and filing separately
with your spouse, you will have to combine your Montana
adjusted gross income with your spouse’s to determine the
amount of your retirement disability income exclusion.
What information do I need to provide to show proof of
my disability?
We may ask for proof issued by a governmental unit (such
as the Social Security Administration) that certifies that you
are permanently and totally disabled. If this is not available,
we may require other verification that can prove your
disability.
Administrative Rules of Montana: 42.15.217
Questions? Call us toll free at (866) 859-2254 (in Helena,
444-6900).