Form 2441 Child and Dependent Care Expenses

Form

2441

Child and Dependent Care Expenses

OMB No. 1545-0074

1040

..........

1040A

..........

© Attach

Department of the Treasury
Internal Revenue Service (99)

2441

separate instructions.

1

Attachment
Sequence No. 21
Your social security number

Name(s) shown on return

Part I

2009

1040NR

to Form 1040, Form 1040A, or Form 1040NR.
© See

§

Persons or Organizations Who Provided the Care—You must complete this part.
(If you have more than two care providers, see the instructions.)

(a) Care provider’s
name

(b) Address
(number, street, apt. no., city, state, and ZIP code)

(c) Identifying number
(SSN or EIN)

(d) Amount paid
(see instructions)

© Complete only Part II below.
Did you receive
No
dependent care benefits?
© Complete Part III on the back next.
Yes
Caution. If the care was provided in your home, you may owe employment taxes. If you do, you cannot file Form 1040A. For details,
see the instructions for Form 1040, line 59, or Form 1040NR, line 56.

Part II
2

Credit for Child and Dependent Care Expenses

Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions.
(b) Qualifying person’s social
security number

(a) Qualifying person’s name
First

Last

3

Add the amounts in column (c) of line 2. Do not enter more than $3,000 for one qualifying
person or $6,000 for two or more persons. If you completed Part III, enter the amount
from line 34 . . . . . . . . . . . . . . . . . . . . . . . . . .

4
5

Enter your earned income. See instructions . . . . . . . . . . . . . . .
If married filing jointly, enter your spouse’s earned income (if your spouse was a student
or was disabled, see the instructions); all others, enter the amount from line 4 . . . .

6
7

Enter the smallest of line 3, 4, or 5 . . . . . . .
Enter the amount from Form 1040, line 38; Form
1040A, line 22; or Form 1040NR, line 36. . . . .

8

$0—15,000
15,000—17,000
17,000—19,000
19,000—21,000
21,000—23,000
23,000—25,000
25,000—27,000
27,000—29,000

10
11
12
13

.

.

.

.

.

.

.

.

.

.

3
4
5
6

7
Enter on line 8 the decimal amount shown below that applies to the amount on line 7
If line 7 is:
But not
over
Over

9

.

(c) Qualified expenses you
incurred and paid in 2009 for the
person listed in column (a)

Decimal
amount is
.35
.34
.33
.32
.31
.30
.29
.28

If line 7 is:
But not
over
Over
$29,000—31,000
31,000—33,000
33,000—35,000
35,000—37,000
37,000—39,000
39,000—41,000
41,000—43,000
43,000—No limit

Decimal
amount is
.27
.26
.25
.24
.23
.22
.21
.20

8

Multiply line 6 by the decimal amount on line 8. If you paid 2008 expenses in 2009, see
the instructions . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the amount from Form 1040, line 46; Form
1040A, line 28; or Form 1040NR, line 43. . . . .
10
Enter the amount from Form 1040, line 47; or Form
1040NR, line 44. Form 1040A filers, enter -0- . . .
11
Subtract line 11 from line 10. If zero or less, stop. You cannot take the credit . . . .
Credit for child and dependent care expenses. Enter the smaller of line 9 or line 12
here and on Form 1040, line 48; Form 1040A, line 29; or Form 1040NR, line 45 . . . .

For Paperwork Reduction Act Notice, see page 4 of the instructions.

X.

9

12
13

Cat. No. 11862M

Form 2441 (2009)

Page 2

Form 2441 (2009)

Part III

Dependent Care Benefits

14 Enter the total amount of dependent care benefits you received in 2009. Amounts you
received as an employee should be shown in box 10 of your Form(s) W-2. Do not include
amounts reported as wages in box 1 of Form(s) W-2. If you were self-employed or a
partner, include amounts you received under a dependent care assistance program from
your sole proprietorship or partnership . . . . . . . . . . . . . . . . . .
15 Enter the amount, if any, you carried over from 2008 and used in 2009 during the grace
period. See instructions . . . . . . . . . . . . . . . . . . . . . . .
16 Enter the amount, if any, you forfeited or carried forward to 2010. See instructions
17 Combine lines 14 through 16. See instructions . . . . . . . . . . . .
18 Enter the total amount of qualified expenses incurred
in 2009 for the care of the qualifying person(s) . . .
18
19
19 Enter the smaller of line 17 or 18 . . . . . . . .
20
20 Enter your earned income. See instructions . . . .
21 Enter the amount shown below that applies
to you.
● If

married filing jointly, enter your
spouse’s earned income (if your
spouse was a student or was disabled,
see the instructions for line 5).
● If married filing separately, see
instructions.

%

.

.

.

● All others, enter the amount from line 20.
22 Enter the smallest of line 19, 20, or 21 . . . . . .
23 Enter $5,000 ($2,500 if married filing separately and
you were required to enter your spouse’s earned
income on line 21) . . . . . . . . . . . . .

.
.

.
.

.
.

14
15
16 (
17

)

21

22

23
24 Are you filing Form 1040A?
Yes. Skip lines 24 through 27 and go to line 28.
No. Enter the amount from line 14 that you received from your sole proprietorship or
partnership. If you did not receive any such amounts, enter -0- . . . . . . . . .
25
25 Subtract line 24 from line 17 . . . . . . . . .
26
26 Enter the smaller of line 22 or 23 . . . . . . . .
27 Deductible benefits. Enter the smallest of line 22, 23, or 24. Also, include this amount on
the appropriate line(s) of your return. See instructions . . . . . . . . . . . . .
28 Excluded benefits. Form 1040 and 1040NR filers: Subtract line 27 from line 26. If zero or
less, enter-0-. Form 1040A filers: Enter the smaller of line 22 or line 23 . . . . . . .
29 Taxable benefits. Form 1040 and 1040NR filers: Subtract line 28 from line 25. If zero or
less, enter -0-. Also, include this amount on Form 1040, line 7; or Form 1040NR, line 8. On
the dotted line next to Form 1040, line 7; or Form 1040NR, line 8, enter “DCB.”
Form 1040A filers: Subtract line 28 from line 17. Also, include this amount on Form 1040A,
line 7. In the space to the left of line 7, enter “DCB” . . . . . . . . . . . . . .

24

27
28

29

To claim the child and dependent care
credit, complete lines 30 through 34 below.
30 Enter $3,000 ($6,000 if two or more qualifying persons) . . . . . . . . . . . .
31 Form 1040 and 1040NR filers: Add lines 27 and 28. Form 1040A filers: Enter the amount
from line 28 . . . . . . . . . . . . . . . . . . . . . . . . . . .
32 Subtract line 31 from line 30. If zero or less, stop. You cannot take the credit.
Exception. If you paid 2008 expenses in 2009, see the instructions for line 9 . . . . .
33 Complete line 2 on the front of this form. Do not include in column (c) any benefits shown
on line 31 above. Then, add the amounts in column (c) and enter the total here. . . . .
34 Enter the smaller of line 32 or 33. Also, enter this amount on line 3 on the front of this form
and complete lines 4 through 13 . . . . . . . . . . . . . . . . . . . .

30
31
32
33
34
Form 2441 (2009)