Kansas Certificate of Disability
Extracted from PDF file 2021-kansas-schedule-dis.pdf, last modified September 2020
Certificate of DisabilityDIS 2021 KANSAS 130318 CERTIFICATE OF DISABILITY (Rev. 7-21) If you are claiming homestead benefits because of disability, this form must be completed by a duly licensed physician and enclosed with your Homestead Claim, Form K-40H. Instead of this schedule, you may enclose a copy of your Social Security certification of disability letter that shows you are receiving benefits based upon a total and permanent disability which prevented you from being engaged in any substantial gainful activity during the entire calendar year of 2021. You may enclose a copy of your original Veterans Disability Statement or request a letter from your regional Veterans Administration that includes your disability date and percentage of permanent disability. Annual income derived from any substantial gainful activity during 2021 must not exceed the limits set by the Social Security Administration for 2021: $15,720 if the impairment is other than blindness; $26,280 if the individual is blind. NAME OF PERSON EXAMINED __________________________________________________________________________________________________________________________________________________ SOCIAL SECURITY NUMBER______________________________________________________________________________________________________________________________________________________ ADDRESS _____________________________________________________________________________________________________________________________________________________________________________________ Street or RR (Include apartment number or lot number) ______________________________________________________________________________________________________________________________________________________________________________________________________ City State Zip Code 1. Does the individual qualify as having a disability preventing them from engaging in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death and/or has lasted for the entire year of 2021? o YES o NO 2. Nature of disability __________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________ 3. When was the condition originally diagnosed? _______________________________________________________________________________________________________________________ CERTIFICATION OF PHYSICIAN I,______________________________________________________________________________________________________________ , certify that I have personally examined the physical and mental condition of the above named individual. I declare under the penalties of perjury that to the best of my knowledge and belief, this is a true, correct and complete statement. SIGNATURE OF PHYSICIAN ______________________________________________________________________________________________________________________________________________________ PHYSICIAN’S NAME____________________________________________________________________________________________________________________________________________________________________ Please type or print BUSINESS ADDRESS _________________________________________________________________________________________________________________________________________________________________ Street or RR ______________________________________________________________________________________________________________________________________________________________________________________________________ City PHONE __________________________________________________________________________________________ State Zip Code DATE_________________________________________________________________
DIS Certificate of Disability Rev. 7-21
More about the Kansas Schedule DIS Individual Income Tax TY 2021
We last updated the Certificate of Disability in January 2022, so this is the latest version of Schedule DIS, fully updated for tax year 2021. You can download or print current or past-year PDFs of Schedule DIS directly from TaxFormFinder. You can print other Kansas tax forms here.
Other Kansas Individual Income Tax Forms:
|Form Code||Form Name|
|Form K-40||Individual Income Tax Return|
|Schedule S||Individual Income Tax Supplemental Schedule|
|Form K-40V||Kansas Payment Voucher|
|Form K-40ES||Individual Estimated Income Tax Vouchers|
|Form K-40H||Homestead Claim|
Kansas usually releases forms for the current tax year between January and April. We last updated Kansas Schedule DIS from the Department of Revenue in January 2022.
About the Individual Income Tax
The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.
Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!
Historical Past-Year Versions of Kansas Schedule DIS
We have a total of eight past-year versions of Schedule DIS in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
DIS Certificate of Disability Rev. 7-21
2020 Homestead or Property Tax Refund for Homeowners Instruction Booklet Rev. 8-20
DIS Certificate of Disability Rev. 7-19
DIS Certificate of Disability Rev. 8-18
DIS Certificate of Disability Rev. 7-17
DIS Certificate of Disability Rev. 8-16
2015 Homestead Claim Instructions and Forms
DIS Certificate of Disability (Rev. 8-12)
While we do our best to keep our list of Kansas Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.