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

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Dependent Care Provider’s Identification and Certification
(Rev. August 1996)
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
Allowance Certificate, to have income tax withheld, a copy of
General Instructions
that Form W-4.
Section references are to the Internal Revenue Code.
If your care provider does not comply with your request for
one of these items, you must still report certain information on
Purpose of form.—You must get the information shown in
your Form 2441 or Schedule 2, whichever applies. For details,
Part I from each person or organization that provides care for
see the Form 2441 or Schedule 2 instructions.
your child or other dependent if:
1. You plan to claim a credit for child and dependent care
Specific Instructions
expenses on Form 1040 or 1040A, or
2. You receive benefits under your employer’s dependent care
Part I
The individual or organization providing the care completes this
If either 1 or 2 above applies, you must show the correct
name, address, and taxpayer identification number (TIN) of each
Enter the provider’s name, address, and TIN. For individuals
care provider on Form 2441, Child and Dependent Care
and sole proprietors, the TIN is a social security number (SSN).
Expenses, or Schedule 2, Child and Dependent Care Expenses
But if the provider is a nonresident or resident alien who does
for Form 1040A Filers, whichever applies.
not have and is not eligible to get an SSN, the TIN is an IRS
You may use Form W-10 or any of the other sources listed
individual taxpayer identification number (ITIN). For other entities,
under Due diligence below to get this information from each
it is the employer identification number. If the provider is exempt
from Federal income tax as an organization described in section
Penalty for failure to furnish TIN.—TINs are needed to carry
501(c)(3), see Tax-exempt dependent care provider below.
out the Internal Revenue laws of the United States. Section
How to get a TIN.—Providers who do not have a TIN should
6109(a) requires a provider of dependent care services to give to
apply for one immediately. To apply for an SSN, get Form SS-5,
you a valid TIN, even if the provider is not required to file a
Application for a Social Security Card, from your local Social
return. The IRS uses the TIN to identify the provider and verify
Security Administration office. To apply for an ITIN, get Form
the accuracy of the provider’s return as well as yours.
W-7, Application for IRS Individual Taxpayer Identification
A care provider who does not give you his or her correct TIN
Number, from the IRS. To apply for an EIN, get Form SS-4,
is subject to a penalty of $50 for each failure unless the failure is
Application for Employer Identification Number, from the IRS.
due to reasonable cause and not willful neglect. This penalty
Note: An ITIN is for tax use only. It does not entitle the individual
does not apply to an organization described in section 501(c)(3).
to social security benefits or change his or her employment or
See Tax-exempt dependent care provider later.
immigration status under U.S. law.
If incorrect information is reported.—You will not be allowed
Tax-exempt dependent care provider.—A provider who is a
the tax credit or the exclusion for employer-provided dependent
tax-exempt organization described in section 501(c)(3) and
care benefits if:
exempt under section 501(a) is not required to supply its TIN.
You report an incorrect name, address, or TIN of the provider
Instead, the provider must complete the name and address lines
on your Form 2441 or Schedule 2, and
and write “tax-exempt” in the space for the TIN. Generally, an
exempt 501(c)(3) organization is one organized and operated
You cannot establish, to the IRS upon its request, that you
exclusively for religious, charitable, scientific, testing for public
used due diligence in trying to get the required information.
safety, literary, or educational purposes, or for the prevention of
Due diligence.—You can show due diligence by getting and
cruelty to children or animals.
keeping in your records any one of the following:
Income tax reporting requirements for dependent care
A Form W-10 properly completed by the provider.
providers.—The individual provider must report on his or her
A copy of the provider’s social security card or driver’s license
income tax return all income received for providing care for any
that includes his or her social security number.
person. If the provider is a self-employed individual, the income
A recently printed letterhead or printed invoice that shows the
is reported on Schedule C or C-EZ (Form 1040), whichever
provider’s name, address, and TIN.
If the provider is your employer’s dependent care plan, a copy
Part II
of the statement provided by your employer under the plan.
If the provider is your household employee and he or she gave
Complete this part only if you are leaving the form with the
you a properly completed Form W-4, Employee’s Withholding
dependent care provider to return to you later.
Cat. No. 10437N
(Rev. 8-96)


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