EFTA01222638.pdf

OMB No. 1545-0074 Forth 2441 Child and Dependent Care Expenses 1040 1040A lo Attach to Form 1040, Form 1040A, or Form 1040NR. 1040NR 2017 Department of the Treasury ► Go to www.irs.gov/Form2441 for Instructions and the Attachment internal Revenue Senice (991 latest Information. Sequence No. 21 Name(s) sho'm on return Your social security number Part I Persons or Organizations Who Provided the Care-You must complete this part. (If you have more than two care providers, see the instructions.) 1 (a) Care providers (b) Address (a) Identifying number (d) Amount pad name (number. street. apt. no.. city. state, and ZIP code) (SSN cr EIN) (see instructions) Did you receive No --10. Complete only Part II below. dependent care benefits? Yes -OP. Complete Part III on the back next. Caution: If the care was provided in your home, you may owe employment taxes. If you do. you can't file Form 1040A. For details, see the instructions for Form 1040. line 60a. or Form 1040NR. line 59a. Part II Credit for Child and Dependent Care Expenses 2 Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions. (a) Qualifying person's name (b) Qualifying person's social (o) Ouallfled expenses you security number inctrred and paid in 2017 for the First person fisted in column (a) 3 Add the amounts in column (c) of line 2. Don't enter more than $3,000 for one qualifying person or $6.000 for two o more persons. If you completed Part Ill, enter the amount from line 31 3 4 Enter your earned income. See instructions 4 5 It 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 5 6 Enter the smallest of line 3, 4, or 5 7 Enter the amount from Form 1040, line 38: Form 1040A, line 22; or Form 1040NR. line 37 I l 8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7 If line 7 is: If line 7 is: But not Decimal But not Decimal Over over amount is Over over amount is $0-15.000 .35 $29,000-31.000 .27 15.000-17.000 .34 31,000-33.000 .26 17.000-19.000 .33 33,000-35.000 .25 19.000-21.000 .32 35,000-37.000 .24 21.000-23.000 .31 37,000-39,000 .23 23.000-25.000 .30 39,000-41,000 .22 25.000-27.000 .29 41,000-43,000 .21 27.000-29.000 .29 43.000—No limit .20 9 Multiply line 6 by the decimal amount on line 8. If you paid 2016 expenses in 2017, see the instructions 10 Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions 1 10 I I 11 Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 49: Form 1040A. line 31; or Form 1040NR, line 47 . . . . 11 For Paperwork Reduction Act Notice, see your tax return instructions. Form 2441 (20171 EFTA01222638 Form 2441 (2017) Page 2 WM Dependent Care Benefits 12 Enter the total amount of dependent care benefits you received in 2017. 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 12 13 Enter the amount, if any, you carried over from 2016 and used in 2017 during the grace period. See instructions 13 14 Enter the amount, if any, you forfeited or carried forward to 2018. See instructions 14 ( 15 Combine lines 12 through 14. See instructions 15 16 Enter the total amount of qualified expenses incurred in 2017 for the care of the qualifying person(s) . . 17 Enter the smaller of line 15 or 16 18 Enter your earned income. See instructions . . . 19 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). • If married filing separately, see instructions. • All others, enter the amount from line 18. 20 Enter the smallest of line 17, 18, or 19 21 Enter $5,000 ($2,500 if marled filing separately and you were required to enter your spouse's earned income on line 19) 22 Is any amount on line 12 from your sole proprietorship or partnership? (Form 1040A filers go to line 25.) O No. Enter -0-. O Yes. Enter the amount here 22 23 Subtract line 22 from line 15 I 23 I 24 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 24 25 Excluded benefits. Form 1040 and 1040NR filers: 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-. Form 1040A filers: Enter the smaller of line 20 or line 21 . . 25 26 Taxable benefits. Form 1040 and 1040NR filers: Subtract line 25 from line 23. 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 25 from line 15. Also, include this amount on Form 1040A, line 7. In the space to the left of line 7, enter "DCB" 26 To claim the child and dependent care credit, complete lines 27 through 31 below. 27 Enter $3,000 ($6,000 if two or more qualifying persons) 27 28 Form 1040 and 1040NR filers: Add lines 24 and 25. Form 1040A filers: Enter the amount from line 25 28 29 Subtract line 28 from line 27. If zero or less, stop. You can't take the credit. Exception. If you paid 2016 expenses in 2017, see the instructions for line 9 . . . . . 29 30 Complete line 2 on the front of this form. Don't include in column (c) any benefits shown on line 28 above. Then, add the amounts in column (c) and enter the total here. . . . . 30 31 Enter the smaller of line 29 or 30. Also, enter this amount on line 3 on the front of this form and complete lines 4 through 11 31 Form 2441 Rom EFTA01222639