_ . _ _ _ _ _ . _ _ _ _ State of Rhode Island Division of Taxation 2022 Modification Worksheet Taxable Social Security Income Worksheet Enter your spouse’s date of birth, if applicable............................................................................................... 2 2 Enter your Federal AGI from RI-1040 or RI-1040NR, line 1........................................................................... 3 3 Enter your Filing Status.................................................................................................................................. 4 4 5 Were either you or your spouse born on or before 09/01/1956? If yes, check the box to the right. 6 5 Filing status amount. Enter the amount from below that corresponds to your filing status on line 4............. 6 Single or head of household -

$95,800 Married filing separately -

$95,800 7 Is your Federal AGI on line 3 less than the filing status amount on line 6? If yes, check the box to the right.. 7 If you answered yes to both questions 5 and 7, continue to Step 2. Otherwise, STOP, you are not eligible for this modification. STEP 2: Modification Amount If you AND your spouse, if applicable, were born on or before 09/01/1956, enter 1.0000 on line 12 and skip lines 8 through 10. Amount of social security benefits from Federal Form 1040 or 1040-SR, line 6a.......................................... 8 8 9 Amount of line 8 attributed to the person born on or before 09/01/1956.................................................................... 10 9 Eligible percentage of social security benefits. Divide line 9 by line 8........................................................... 10 Name Social security number MODIFICATION FOR TAXABLE SOCIAL SECURITY INCOME WORKSHEET STEP 1: Eligibility Enter your date of birth................................................................................................................................... 1 1 11 Taxable amount of social security from Federal Form 1040 or 1040-SR, line 6b........................................... 12 11 Eligible percentage. Enter the percentage from line 10, or 1.0000, whichever applies..................................... 13 12 Modification Amount. Multiply line 11 by line 12. Enter here and on Schedule M - page 1, line 1s. 13 NOTE: Use this worksheet to determine the amount, if any, of your Social Security modification on Schedule M, line 1s. Yes Yes Married filing jointly or qualifying widow(er) - $119,750 Page 18 IMAGEONLY