Form W-10 Dependent Care Provider'S Identification And Certification


Dependent Care Provider’s Identification and Certification
(Rev. August 1992)
Do NOT file Form W-10 with your tax return. Instead, keep it for your records.
Department of the Treasury
Internal Revenue Service
Part I
Dependent Care Provider’s Identification (See instructions.)
Name of dependent care provider
Provider’s taxpayer identification number
Address (number, street, and apt. no.)
If the above number is a social security
number, check here
City, state, and ZIP code
Certification and Signature of Dependent Care Provider.—Under penalties of perjury, I, as the dependent care provider, certify
that my name, address, and taxpayer identification number shown above are correct.
Dependent care provider’s signature
Part II
Name and Address of Person Requesting Part I Information (See instructions.)
Name, street address, apt. no., city, state, and ZIP code of person requesting information
If Incorrect Information Is Reported
Enter the provider’s name, address, and
General Instructions
TIN. For individuals and sole
You will not be allowed the tax credit or
(Section references are to the Internal
proprietors, the TIN is a social security
the exclusion for employer-provided
Revenue Code.)
number. For other entities, it is the
dependent care benefits if:
employer identification number. If the
You report an incorrect name, address,
provider is exempt from Federal income
or TIN of the provider on your Form 2441
You must get the information shown in
tax as an organization described in section
or Schedule 2, and
Part I from each person or organization
501(c)(3), see Tax-exempt dependent
that provides care for your child or other
You cannot establish, to the IRS upon
care provider below.
dependent if:
its request, that you used due diligence in
How to get a TIN.—Providers who do not
trying to get the required information.
1. You plan to claim a credit for child
have a TIN should apply for one
and dependent care expenses on your
immediately. To apply for a number,
Due Diligence
Form 1040 or 1040A, or
individuals and sole proprietors should get
You can show due diligence by getting and
2. You receive benefits under your
Form SS-5, Application for a Social
keeping in your records any one of the
employer’s dependent care plan.
Security Card, from their local Social
Security Administration office. Other
If either 1 or 2 above applies, you must
A Form W-10 properly completed by the
entities should get Form SS-4, Application
show the correct name, address, and
for Employer Identification Number, from
taxpayer identification number (TIN) of
their local Internal Revenue Service office.
A copy of the provider’s social security
each care provider on Form 2441, Child
card or driver’s license (in a state where
and Dependent Care Expenses, or
Tax-exempt dependent care provider.—A
the license includes the social security
Schedule 2, Child and Dependent Care
provider who is a tax-exempt organization
Expenses for Form 1040A Filers, whichever
described in section 501(c)(3) and exempt
A recently printed letterhead or printed
under section 501(a) is not required to
invoice that shows the provider’s name,
supply its TIN. Instead, the provider must
You may use Form W-10 or any of the
address, and TIN.
complete the name and address lines and
other sources listed under Due Diligence
write "tax-exempt" in the space for the
on this page to get this information from
If the provider is your employer’s
TIN. Generally, an exempt 501(c)(3)
each provider.
dependent care plan, a copy of the
organization is one organized and operated
statement provided by your employer
Penalty for Failure To Furnish TIN
exclusively for religious, charitable,
under the plan.
Taxpayer identification numbers are
scientific, testing for public safety, literary,
If the provider is your household
or educational purposes, or for the
needed to carry out the Internal Revenue
employee and he or she gave you a
prevention of cruelty to children or animals.
laws of the United States. Section 6109(a)
properly completed Form W-4, Employee’s
requires the providers of your dependent
Income tax reporting requirements for
Withholding Allowance Certificate, to have
care services to give you their TIN. The IRS
dependent care providers.—The
income tax withheld, a copy of that Form
uses the TIN for identification purposes
individual provider must report on his or
and to help verify the accuracy of the
her income tax return all income received
If your care provider does not comply
provider’s return as well as yours.
for providing care for any person. If the
with your request for one of these items,
Providers must give you their TIN even if
provider is a self-employed individual, the
you must still report certain information on
they are not required to file a tax return.
income is reported on Schedule C or C-EZ
your Form 2441 or Schedule 2, whichever
(Form 1040), whichever applies. For
A care provider who does not give you
applies. For details, see the Form 2441 or
information on reporting this income, see
his or her correct TIN is subject to a
Schedule 2 instructions.
the Instructions for Form 1040.
penalty of $50 for each failure unless the
failure is due to reasonable cause and not
Specific Instructions
Part II
willful neglect. This penalty does not apply
Part I
Complete this part only if your care
to an organization described in section
provider is going to return the form to you
501(c)(3). See Tax-exempt dependent
The individual or organization providing the
care provider on this page.
care completes this part.
Cat. No. 10437N
(Rev. 8-92)


00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial