Form 2441 - Child And Dependent Care Expenses - 2012 Page 2
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Form 2441 (2012)
Page
Part III
Dependent Care Benefits
12 Enter the total amount of dependent care benefits you received in 2012. Amounts you
received as an employee should be shown in box 10 of your Form(s) W-2. Do not 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 .
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13 Enter the amount, if any, you carried over from 2011 and used in 2012 during the grace
period. See instructions .
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14 (
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14 Enter the amount, if any, you forfeited or carried forward to 2013. See instructions
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15 Combine lines 12 through 14. See instructions .
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15
16 Enter the total amount of qualified expenses incurred
in 2012 for the care of the qualifying person(s) .
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17 Enter the smaller of line 15 or 16 .
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18 Enter your earned income. See instructions .
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19 Enter
the
amount
shown
below
that
applies
to you.
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• If married filing jointly, enter your
spouse’s
earned
income
(if
your
spouse was a student or was disabled,
see the instructions for line 5).
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19
• If married filing separately, see
instructions.
• All others, enter the amount from line 18.
20 Enter the smallest of line 17, 18, or 19 .
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21 Enter $5,000 ($2,500 if married filing separately and
you were required to enter your spouse’s earned
income on line 19) .
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22 Is any amount on line 12 from your sole proprietorship or partnership? (Form 1040A filers
go to line 25.)
No. Enter -0-.
Yes. Enter the amount here
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23 Subtract line 22 from line 15 .
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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 .
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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 . .
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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” .
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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)
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28 Form 1040 and 1040NR filers: Add lines 24 and 25. Form 1040A filers: Enter the amount
from line 25 .
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29 Subtract line 28 from line 27. If zero or less, stop. You cannot take the credit.
Exception. If you paid 2011 expenses in 2012, see the instructions for line 9 .
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30 Complete line 2 on the front of this form. Do not include in column (c) any benefits shown
on line 28 above. Then, add the amounts in column (c) and enter the total here.
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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 .
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31
2441
Form
(2012)
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