2441 Child and Dependent Care Expenses

Version A, Cycle 12

2441

Child and Dependent Care Expenses

Department of the Treasury
Internal Revenue Service

Attach to Form 1040, 1040-SR, or 1040-NR.
Go to www.irs.gov/Form2441 for instructions and the latest information.

Form

OMB No. 1545-0074

2022

Attachment
Sequence No. 21
Your social security number

Name(s) shown on return

A You can’t claim a credit for child and dependent care expenses if your filing status is married filing separately unless you meet the
requirements listed in the instructions under Married Persons Filing Separately. If you meet these requirements, check this box . .
B If you or your spouse was a student or was disabled during 2022 and you’re entering deemed income of $250 or $500 a month on
Form 2441 based on the income rules listed in the instructions under If You or Your Spouse Was a Student or Disabled, check this box .

Part I

1

Persons or Organizations Who Provided the Care—You must complete this part.
If you have more than three care providers, see the instructions and check this box . . . . . . . .

(a) Care provider’s
name

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

(d) Was the care provider your
household employee in 2022?
(c) Identifying number
For example, this generally includes
(SSN or EIN)
nannies but not daycare centers.
(see instructions)

Yes

No

Yes

No

Yes

No

(e) Amount paid
(see instructions)

INTERNAL USE ONLY
DRAFT AS OF
July 28, 2022
Did you receive
dependent care benefits?

No

Complete only Part II below.

Yes

Complete Part III on page 2 next.

Caution: If the care provider is your household employee, you may owe employment taxes. For details, see the Instructions for
Schedule H (Form 1040). If you incurred care expenses in 2022 but didn’t pay them until 2023, or if you prepaid in 2022 for care to
be provided in 2023, don’t include these expenses in column (d) of line 2 for 2022. See the instructions.

Part II
2

Credit for Child and Dependent Care Expenses

Information about your qualifying person(s). If you have more than three qualifying persons, see the instructions and check this box
(a) Qualifying person’s name

First

(b) Qualifying person’s
social security number

Last

(c) Check here if the
qualifying person was over
age 12 and was disabled.
(see instructions)

3

Add the amounts in column (d) of line 2. Don’t enter more than $3,000 if you had one qualifying person
or $6,000 if you had two or more persons. If you completed Part III, enter the amount from line 31

4
5

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

6
7
8

Enter the smallest of line 3, 4, or 5 . . . . . . . . . . . . . . . . .
Enter the amount from Form 1040, 1040-SR, or 1040-NR, line 11 . . .
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
$0—15,000
15,000—17,000
17,000—19,000
19,000—21,000
21,000—23,000
23,000—25,000

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

If line 7 is:
Over

But not
over

$25,000—27,000
27,000—29,000
29,000—31,000
31,000—33,000
33,000—35,000
35,000—37,000

Decimal
amount is
.29
.28
.27
.26
.25
.24

If line 7 is:
Over

But not
over

$37,000—39,000
39,000—41,000
41,000—43,000
43,000—No limit

.

.

.

(d) Qualified expenses
you incurred and paid
in 2022 for the person
listed in column (a)

3
4
5
6

Decimal
amount is
.23
.22
.21
.20

9a Multiply line 6 by the decimal amount on line 8 . . . . . . . . . . . . . . . .
b If you paid 2021 expenses in 2022, complete Worksheet A in the instructions. Enter the amount
from line 13 of the worksheet here. Otherwise, enter -0- on line 9b and go to line 9c . . . .
c Add lines 9a and 9b and enter the result
. . . . . . . . . . . . . . . . . .
10
Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions 10
11
Credit for child and dependent care expenses. Enter the smaller of line 9c or line 10 here and
on Schedule 3 (Form 1040), line 2 . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 11862M

8

X.

9a
9b
9c

11
Form 2441 (2022)

Version A, Cycle 12
Page 2

Form 2441 (2022)

Part III

Dependent Care Benefits

12

Enter the total amount of dependent care benefits you received in 2022. Amounts you received
as an employee should be shown in box 10 of your Form(s) W-2. Don’t 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 . . . . . . . . . . . . . . . . . . . . . . . . . . .

13
14

Enter the amount, if any, you carried over from 2020 and/or 2021 and used in 2022. See instructions
If you forfeited or carried over to 2023 any of the amounts reported on line 12 or 13, enter the
amount. See instructions . . . . . . . . . . . . . . . . . . . . . . . .

15
16

Combine lines 12 through 14. See instructions . . . . . . .
Enter the total amount of qualified expenses incurred in 2022 for
the care of the qualifying person(s) . . . . . . . . . .

17
18
19

Enter the smaller of line 15 or 16 . . . . . . .
Enter your earned income. See instructions . . .
Enter the amount shown below that applies to you.
• If married filing jointly, enter your spouse’s
earned income (if you or your spouse was a
student or was disabled, see the instructions
.
for line 5).

20
21

22

23
24
25
26

• If married filing separately, see instructions.
• All others, enter the amount from line 18.
Enter the smallest of line 17, 18, or 19 . . .

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16
17
18

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19

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12
13
14 (
15

)

INTERNAL USE ONLY
DRAFT AS OF
July 28, 2022
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20

Enter $5,000 ($2,500 if married filing separately and you were
required to enter your spouse’s earned income on line 19). If you
entered an amount on line 13, add it to the $5,000 or $2,500
amount you enter on line 21. However, don’t enter more than the
maximum amount allowed under your dependent care plan. If your
dependent care plan uses a non-calendar plan year, see
instructions . . . . . . . . . . . . . . . . . .

21
Is any amount on line 12 or 13 from your sole proprietorship or partnership?
No. Enter -0-.
Yes. Enter the amount here . . . . . . . . . . . . . . . . . . . . . .
Subtract line 22 from line 15
. . . . . . . . . . . .
23
Deductible benefits. Enter the smallest of line 20, 21, or 22. Also, include this amount on the
appropriate line(s) of your return. See instructions . . . . . . . . . . . . . . .
Excluded benefits. If you checked “No” on line 22, enter the smaller of line 20 or 21. Otherwise,
subtract line 24 from the smaller of line 20 or line 21. If zero or less, enter -0- . . . . . .
Taxable benefits. Subtract line 25 from line 23. If zero or less, enter -0-. Also, enter this amount
on Form 1040, 1040-SR, or 1040-NR, line 1e . . . . . . . . . . . . . . . . .

22

24
25
26

To claim the child and dependent care credit,
complete lines 27 through 31 below.
27
28
29
30
31

Enter $3,000 ($6,000 if two or more qualifying persons) . . . . . . . . . . . . . .
Add lines 24 and 25 . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 28 from line 27. If zero or less, stop. You can’t take the credit. Exception. If you
paid 2021 expenses in 2022, see the instructions for line 9b . . . . . . . . . . . .
Complete line 2 on page 1 of this form. Don’t include in column (d) any benefits shown on line
28 above. Then, add the amounts in column (d) and enter the total here . . . . . . . .
Enter the smaller of line 29 or 30. Also, enter this amount on line 3 on page 1 of this form and
complete lines 4 through 11 . . . . . . . . . . . . . . . . . . . . . . .

27
28
29
30
31
Form 2441 (2022)