Form 2441 - Child and Dependent Care Expenses (2014)
Form 2441
Department of the Treasury
Internal Revenue Service (99)
Child and Dependent Care Expenses
▶
Attach to Form 1040, Form 1040A, or Form 1040NR.
▶
Information about Form 2441 and its separate instructions is at
www.irs.gov/form2441.
1040A
. . . . . . . . . .
1040
2441
◀
. . . . . . . . . .
1040NR
OMB No. 1545-0074
2014
Attachment
Sequence No.
21
Name(s) shown 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 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)
Did you receive
dependent care benefits?
No
▶
Complete only Part II below.
Yes
▶
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 cannot 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
First
Last
(b) Qualifying person’s social
security number
(c) Qualified expenses you
incurred and paid in 2014 for the
person listed in column (a)
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 31 . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4 Enter your earned income. See instructions . . . . . . . . . . . . . . . 4
5
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 .
5
6 Enter the smallest of line 3, 4, or 5 . . . . . . . . . . . . . . . . . . 6
7
Enter the amount from Form 1040, line 38; Form
1040A, line 22; or Form 1040NR, line 37. . . . .
7
8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7
If line 7 is:
Over
But not
over
Decimal
amount is
$0—15,000 .35
15,000—17,000 .34
17,000—19,000 .33
19,000—21,000 .32
21,000—23,000 .31
23,000—25,000 .30
25,000—27,000 .29
27,000—29,000 .28
If line 7 is:
Over
But not
over
Decimal
amount is
$29,000—31,000 .27
31,000—33,000 .26
33,000—35,000 .25
35,000—37,000 .24
37,000—39,000 .23
39,000—41,000 .22
41,000—43,000 .21
43,000—No limit .20
8
X .
9 Multiply line 6 by the decimal amount on line 8. If you paid 2013 expenses in 2014, see
the instructions . . . . . . . . . . . . . . . . . . . . . . . . .
9
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 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.
Cat. No. 11862M
Form 2441 (2014)
Page 1/2
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