MONTANA
DCAC
Clear Form
Rev 02 16
2016 Dependent Care Assistance Credits
Name (as it appears on your Montana tax return)
Social Security
Federal Employer
-
-
OR
-
Number
Identification Number
Part I. Partners in a Partnership or Shareholders of an S Corporation
Enter your portion of the dependent care assistance credit here. See instructions.
$___________________
Business Name of Partnership or S Corporation
Federal Employer
-
Identification Number
___________________________________________________
Part II. Dependent Care Assistance Credit (15-30-2373 and 15-31-131, MCA)
1. Enter here the total amount of dependent care assistance that you furnished your
employees .........................................................................................................................1.
2. Enter here the total number of employees who were provided this service ......................2.
3. Divide the amount on line 1 by the number on line 2 and enter that result or $6,300,
whichever is smaller ..........................................................................................................3.
4. Multiply the amount on line 3 by 0.25 (25%) and enter the smaller of that result
or $1,575 ...........................................................................................................................4.
5. Multiply the amount on line 4 by the amount on line 2 and enter the result here. This is
your dependent care assistance credit. ........................................................................5.
Part III. Dependent Care Information and Referral Services Credit (15-30-2373 and 15-31-131, MCA)
1. Enter here the total amount that you paid or incurred during the year for providing
information and referral services to your employees .........................................................1.
2. Multiply the amount on line 1 by 0.25 (25%) and enter the result here. This is your
dependent care information and referral services credit. ...........................................2.
Part IV. Combined Credits
Add the amounts on Part II, line 5; and Part III, line 2. This is your combined
dependent care assistance credit. Your combined credit cannot exceed your tax
liability ...................................................................................................................................
Where to Report Your Credit
►Individuals: Form 2, Schedule V
►S corporations: Form CLT-4S, Schedule II
►C corporations: Form CIT, Schedule C
►Partnerships: Form PR-1, Schedule II
If you file your Montana tax return electronically, you do not need to mail this form to us unless we ask you for a copy. When you
file electronically, you represent that you have retained the required documents in your tax records and will provide them upon the
department’s request.