Schedule 2440W
                                           Disability Income Exclusion
Wisconsin Department of Revenue
                                                (Applies Only to Disabled Retirees Under Age 65)
    Include with Wisconsin                          See instructions on back.                                                                          2024
          Form 1 or 1NPR
Legal name(s) shown on Form 1 or Form 1NPR                                                                           Your social security number

                 Date you retired                   Employer’s name (also give payer’s name, if other than employer)
Yourself
Spouse
                                                                                                                     (1) YOURSELF                      (2) SPOUSE
1  Fill in the amount of your disability pay (see instructions) . . . . . . . . . . . . . . . . . . . .   1
2  Excludable disability pay (see instructions):
(a) Multiply $100 by the number of weeks for which your disability payments
    were at least $100 . Fill in the total   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2a
(b) If you received disability payments of less than $100 for any week,
    fill in the total amount you received for all such weeks   . . . . . . . . . . . . . . . . . .   2b
(c) If you received disability payments for less than a week, fill in the
    smaller amount of either the amount you received or the highest
    exclusion allowable for the period (see instructions)  . . . . . . . . . . . . . . . . . . . .   2c
(d) Add lines 2a, 2b, and 2c . Fill in the total  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2d
3  Add amounts on line 2d, columns (1) and (2) . Fill in the total on line 3    . . . . . . . . . . . . . . . . . . . . . . . . . . .   3
4  Fill in the smaller of line 1 (total of columns (1) and (2)) or line 3   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   4
5  Limit on exclusion (see instructions):
(a) Fill in amount from Form 1, line 3 or Form 1NPR, line 31   . . . . . . . . . . . . . . . .   5a
(b) Amount used to figure any exclusion decrease  . . . . . . . . . . . . . . . . . . . . . . .  .   5b              $15,000 .00
(c) Subtract line 5b from line 5a . If line 5b is more than line 5a, fill in -0-  . . . . . . . . . . . . . . . . . . . . . . . . .   5c
6  Subtract line 5c from line 4 and fill in on line 6 . If line 5c is more than line 4, fill in -0- .
Full-year residents – This is your disability income exclusion . Fill in this amount on line 22 of Schedule
 SB (Form 1) (Part-year residents – complete lines 7 and 8 below .)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   6
7  Part-year residents – Divide line 6 by the number of weeks you received disability payments  . . . . . . . . .   7
8  Part-year residents – Multiply line 7 by the number of weeks you were a Wisconsin resident and 
received disability payments . This is your disability income exclusion . Fill in here and on line 56 of 
Schedule M (Form 1NPR)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   8
9  If you filed a physician’s statement for this disability in an earlier year, check this box .
You do not have to file another statement . If you have not, you must file a physician’s statement (see instructions) .

                        Physician’s Statement of Permanent and Total Disability
                                  Please complete and return to the person named below.
Name of disabled person

I certify that the person named above was (check only one box – please see instructions below)
(1)       Permanently and totally disabled on January 1, 1976, or January 1, 1977 .
(2)       Permanently and totally disabled on the date they retired .  Date retired
Physician’s name                                    Physician’s address

Physician’s signature                                                                                                Date

Instructions for Statement                                                        What is Permanent and Total Disability?
Taxpayer                                  Physician                               A person is permanently and totally disabled when –
Please fill in your name . If you retired • Box (1) applies to taxpayers who      • They cannot engage in any substantial gainful activity
after December 31, 1976, fill in your      retired before January 1, 1977 .       because of a physical or mental condition; and
retirement  date  in  the  space  after   • Box  (2)  applies  to  taxpayers  who • A physician determines that the disability (a) has lasted 
box (2) .                                  retired after December 31, 1976 .      or can be expected to last continuously for at least
                                                                                  a year; or (b) can be expected to result in death .
I-026 (R. 06-24)

                                       2024 Schedule 2440W Instructions

  Purpose of Schedule  Persons who receive disability income may be able to exclude a portion of it from their taxable income . 
Complete this schedule to determine the amount, if any, of your exclusion .

  What is Disability Income  Generally, disability income is the total amount you were paid under your employer’s accident and health 
plan or pension plan instead of wages for the time you were absent from work because of permanent and total disability . However, 
any payment you received from a plan that does not provide for disability retirement is not disability income .

  Who Can Exclude Disability Income  You can take the exclusion for 2024 if you meet ALL these tests:
• You received disability income which is not otherwise exempt from Wisconsin tax .
• You were under age 65 at the end of 2024 (If you were born on January 1, 1959, you are considered to be age 65 at the end of 2024 .)
• You retired on disability and were permanently and totally disabled when you retired . (See "What is Permanent and Total 
 Dis ability?"  below and instructions for Physician’s Statement on page 1 .)
• On January 1, 2024, you had not yet reached the age when your em ployer’s retirement program would have required you to retire .
• For any year prior to 1984, you did not choose to treat your disability income as a pension instead of taking the exclusion .
• If you were married at the end of 2024, you must file a joint return .
• You were a Wisconsin resident when you received the disability income .
If you meet these tests, you can take the exclusion until the earliest of the following dates:
(1) The first day of the tax year in which you turn 65 . (If you were born on January 1, 1959, you are considered to be age 65 at the
     end of 2024 .)
(2) The day you reach the age when your employer’s retirement program would have required you to retire .

  What is Permanent and Total Disability?  A person is permanently and totally disabled if (1) they cannot engage in any substantial 
gainful activity because of a physical or mental condition,  and (2) a 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 . An activity is considered substantial if it consists 
of duties that are more than those of a nonproductive, make-work nature .  An activity is considered gainful if it pays at a rate at or 
above the minimum wage . The examples below show substantial gainful activity . In such cases, the disability income exclusion cannot 
be taken .
Example 1: Sue, who was a sales clerk, retired on disability . Sue now works as a full-time babysitter earning minimum wage . Although 
Sue does different work, Sue babysits on ordinary terms for the minimum wage . Sue cannot take the exclusion because Sue is    
engaged in an activity that is both substantial and gainful .
Example 2: Mary, president of the XYZ Corporation, retired on disability because of a terminal illness . On Mary's doctor's advice, Mary 
works part-time as a manager and is paid more than the minimum wage . Mary's employer sets the days and hours . Although Mary’s 
illness is terminal and works part-time, the work is done at the employer's convenience . Mary is considered engaged in a substantial 
gainful activity and cannot take the exclusion .
 
 Specific Instructions
  Line 1  Fill in the amount of disability pay included in your federal adjusted gross income, less any amount that is otherwise exempt 
from Wisconsin tax (for example, retirement payments received from the U .S . government that relate to service with the Coast Guard, 
the commissioned corps of the National Oceanic and Atmospheric Administration, or the commissioned corps of the Public Health 
Service) .

  Lines 2a and 2b    You can exclude either your actual weekly disability pay or $100 a week, whichever is less . Your weekly pay is 
your total yearly pay divided by 52 .

  Line 2c  If you received disability pay for part of a week, follow the steps below .
Step 1. Divide $100 by the number of days a week you normally worked before you retired .
Step 2. Divide the disability pay you received by the number of days it covered in that week .
Step 3. Compare the Step 1 and Step 2 amounts . The smaller amount is your daily rate . Your exclusion for the week is based on it .
Step 4. Multiply your daily rate by the number of days you received disability pay in the short week . The result is your exclusion for that week .
Step 5. Add your exclusion for that week to your exclusion for any other short weeks . Fill in the total on line 2c .
Disability payments are made for part of a week when one of the following happens after the first day of the taxpayer’s normal workweek:
(1)  The disability retirement begins .
(2)  The disability retirement ends because the taxpayer reaches required retirement age .
(3)  The taxpayer dies .

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  Line 5  Generally, the most a person can exclude is $5,200 . This exclusion goes down, dollar for dollar, by any amount over $15,000 
on line 5a .
Generally, no exclusion is left if line 5a is –
• $20,200 or more, and one person could take the exclusion .
• $25,400 or more, and both spouses could take the exclusion .

  Physician’s Statement  If you did not check the box on line 9 of Schedule 2440W, you must have your physician complete a state-
ment of permanent and total disability . You can use the statement on Schedule 2440W for this purpose . However, if you are filing 
federal Schedule R and your physician completed a Physician's Statement for use with that form, you may submit a copy of that 
statement instead of completing the physician's statement on Schedule 2440W . If both spouses take the exclusion, each must file a 
statement . If you retired on disability before January 1, 1977, the physician’s statement must show that you were permanently and 
totally disabled on January 1, 1976, or January 1, 1977 . If you retired on disability after 1976, the physician’s statement must show 
that you were permanently and totally disabled when you retired .

If the Department of Veterans Affairs (VA) certifies that you are permanently and totally disabled, you can file VA Form 21-0172 in-
stead 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 VA Form 
21-0172 from your local VA regional office .

                                               Applicable Laws and Rules
This  document  provides  statements  or  interpretations  of  the  following  laws  and  regulations  in  effect  as  of  June  6,  2024:  
ch . 71, Wis . Stats ., 

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