Schedule R
(Form 1040)
Department of the Treasury
Internal Revenue Service (99)
Credit for the Elderly or the Disabled
▶ Attach to Form 1040 or 1040-SR.
▶ Go to www.irs.gov/ScheduleR for instructions and the latest information.
1040
1040-SR
. . . . . . . . .
R
◀
OMB No. 1545-0074
2021
Attachment
Sequence No. 16
Name(s) shown on return Your social security number
You may be able to take this credit and reduce your tax if by the end of 2021:
• You were age 65 or older or
• You were under age 65, you retired on permanent and total disability, and
you received taxable disability income.
But you must also meet other tests. See instructions.
TIP In most cases, the IRS can figure the credit for you. See instructions.
Part I Check the Box for Your Filing Status and Age
If your filing status is: And by the end of 2021: Check only one box:
Single,
Head of household, or
Qualifying widow(er)
1You were 65 or older . . . . . . . . . . . . . . . . . . . . 1
2You were under 65 and you retired on permanent and total disability . . 2
Married filing
jointly
3Both spouses were 65 or older . . . . . . . . . . . . . . . . . 3
4Both spouses were under 65, but only one spouse retired on permanent and
total disability ....................... 4
5Both spouses were under 65, and both retired on permanent and total
disability......................... 5
6One spouse was 65 or older, and the other spouse was under 65 and retired
on permanent and total disability . . . . . . . . . . . . . . . . 6
7One spouse was 65 or older, and the other spouse was under 65 and not
retired on permanent and total disability . . . . . . . . . . . . . 7
Married filing
separately
8
You were 65 or older and you lived apart from your spouse for all of 2021 . .
8
9You were under 65, you retired on permanent and total disability, and you
lived apart from your spouse for all of 2021 . . . . . . . . . . . . 9
Did you check
box 1, 3, 7, or 8?
Yes ▶Skip Part II and complete Part III on the back.
No ▶Complete Parts II and III.
Part II Statement of Permanent and Total Disability (Complete only if you checked box 2, 4, 5, 6, or 9 above.)
If: 1You 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
2Due to your continued disabled condition, you were unable to engage in any substantial gainful activity
in 2021, check this box ............................. ▶
• If you checked this box, you don’t have to get another statement for 2021.
• If you didn’t check this box, have your physician complete the statement in the instructions. You must
keep the statement for your records.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11359K Schedule R (Form 1040) 2021
