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2019 Form PTR-1 Instructions
only the income you yourself received (do not of income, you cannot apply it against income or
include your deceased spouse’s income). Joint gains in a different category. In the case of a net
income must be apportioned to reflect the amount loss in any category, leave that line blank.
you received.
Enter dollars and cents in the fields as shown:
2018 Income Eligibility. If your total 2018 in-
come on line 7 was $89,013 or less, you meet the a. Social Security Benefits...
income eligibility requirement for 2018 (see chart
on page 7). Continue to line 8 and check your in- Line A
come eligibility for 2019. Enter the total amount of Social Security or Rail-
road Retirement benefits (including Medicare
If the amount on line 7 is over $89,013, STOP. Part B premiums) from Box 5 of Form SSA-1099
You are not eligible, and you should not file or Form RRB-1099.
this application.
Line B
Line 8 Enter the total amount (after adjustments below) of
Total 2019 Income. List all the income you re- pension and annuity payments, including IRA with-
ceived in 2019. Add the amounts on lines a drawals, that you reported as Pensions, Annuities,
through q and enter the result on line 8. If you and IRA Withdrawals on your New Jersey resident
were married or in a civil union as of Decem- Income Tax Return, Form NJ-1040 (line 20a). If
ber 31, 2019, and living in the same household, you are required to file Form NJ-1040, you must
you must combine your income with your spouse’s complete that line before you complete your
income. If your spouse died during 2019 and your PTR-1 application.
status on December 31, 2019, was “Single,” list
only the income you yourself received (do not If you are not required to file Form NJ-1040, you
include your deceased spouse’s income). Joint must calculate the amount you would have re-
income must be apportioned to reflect the amount ported as Pensions, Annuities, and IRA Withdraw-
you received. als if you did file the return. For your convenience,
a copy of the instructions for completing that line
2019 Income Eligibility. If your total 2019 income of Form NJ-1040 has been included in this booklet
on line 8 was $91,505 or less, you meet the in- as Appendix A. You can use those instructions to
come eligibility requirement for 2019. (See chart calculate the amount for both 2018 and 2019.
on page 7.) Continue completing the application
with line 9. Adjustments. For purposes of this program, you
must make adjustments as follows:
If the amount on line 8 is over $91,505, STOP.
You are not eligible, and you should not file 1. Add any amounts received as U.S. military
this application. pension or survivor’s benefit payments.
2. Add any amounts received as a total and per-
Income Categories manent disability pension before you reached
With very few exceptions, all income that you age 65. Note: Once you reach age 65, you
received during the year, including income that must include any payments you receive from a
you are not required to report on your New Jersey disability pension.
Income Tax return, must be taken into account
to determine eligibility for the Senior Freeze. In 3. Add the portion of any distribution from a Roth
most cases, you must report on your application IRA you received that you would have reported
the total (gross) amount of income you received, if it were a traditional IRA. (See Appendix A.)
whether taxable or nontaxable.
Do not include income from a direct rollover to an-
If you have a loss in one category of income, you other financial instrument, a tax-free exchange of
can apply it against income in the same category. a policy or contract between two insurance com-
However, if you have a net loss in one category panies, or a conversion from an existing traditional
IRA to a Roth IRA.
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