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Publication 575
PencilWorksheet A. Simplified Method
1.Enter the total pension or annuity payments received this year. Also, add this amount to the total for Form 1040, line 16a; Form 1040A, line 12a; or Form 1040NR, line 17a 1.
2.Enter your cost in the plan (contract) at the annuity starting date plus any death benefit exclusion.* See Cost (Investment in the Contract), earlier 2.
Note: If your annuity starting date was before this year and you completed this worksheet last year, skip line 3 and enter the amount from line 4 of last year's worksheet on line 4 below (even if the amount of your pension or annuity has changed). Otherwise, go to line 3.  
3.Enter the appropriate number from Table 1 below. But if your annuity starting date was after 1997 and the payments are for your life and that of your beneficiary, enter the appropriate number from Table 2 below. 3.
4.Divide line 2 by the number on line 34.
5.Multiply line 4 by the number of months for which this year's payments were made. If your annuity starting date was before 1987, enter this amount on line 8 below and skip lines 6, 7, 10, and 11. Otherwise, go to line 6 5.
6.Enter any amounts previously recovered tax free in years after 1986. This is the amount shown on line 10 of your worksheet for last year 6.
7.Subtract line 6 from line 27.
8.Enter the smaller of line 5 or line 78.
9.Taxable amount for year. Subtract line 8 from line 1. Enter the result, but not less than zero. Also, add this amount to the total for Form 1040, line 16b; Form 1040A, line 12b; or Form 1040NR, line 17b.
Note: If your Form 1099-R shows a larger taxable amount, use the amount figured on this line instead. If you are a retired public safety officer, see Insurance Premiums for Retired Public Safety Officers, earlier, before entering an amount on your tax return
10.Was your annuity starting date before 1987?
□ Yes. STOP. Don’t complete the rest of this worksheet.
□ No. Add lines 6 and 8. This is the amount you have recovered tax free through 2016. You will need this number if you need to fill out this worksheet next year
11.Balance of cost to be recovered. Subtract line 10 from line 2. If zero, you won’t have to complete this worksheet next year. The payments you receive next year will generally be fully taxable 11.
* A death benefit exclusion (up to $5,000) applied to certain benefits received by employees who died before August 21, 1996.
Table 1 for Line 3 Above
 IF the age at
annuity starting date was ...
  AND your annuity starting date was—
  BEFORE November 19, 1996,
enter on line 3 ...
AFTER November 18, 1996,
enter on line 3 ...
 55 or under300360
 71 or over120160
Table 2 for Line 3 Above
 IF the combined ages at annuity starting date were ... THEN enter on line 3 ...   
 110 or under 410   
 111-120 360   
 121-130 310   
 131-140 260   
 141 or over 210