OMB No. 1545-0074
                                            Child and Dependent Care Expenses
Form 2441
Department of the Treasury                                Attach to Form 1040, 1040-SR, or 1040-NR.                                                   2022
                                                                                                                                                  Attachment   
Internal Revenue Service          Go to www.irs.gov/Form2441 for instructions and the latest information.                                         Sequence No. 21
Name(s) shown on return                                                                                                            Your social security number

A  You can’t claim a credit for child and dependent care expenses if your filing status is married filing separately unless you meet the 
requirements listed in the instructions under Married Persons Filing Separately. If you meet these requirements, check this box  .                                 .
B  If you or your spouse was a student or was disabled during 2022 and you’re entering deemed income of $250 or $500 a month on 
Form 2441 based on the income rules listed in the instructions under If You or Your Spouse Was a Student or Disabled, check this box .
Part I       Persons or Organizations Who Provided the Care—You must complete this part.   
             If you have more than three care providers, see the instructions and check this box                                         . . . . . . . .
                                                                                                                 (d)  Was the care provider your 
 1   (a)  Care provider’s                            (b)  Address                        (c)  Identifying number household employee in 2022?          (e)  Amount paid  
          name                   (number, street, apt. no., city, state, and ZIP code)        (SSN or EIN)       For example, this generally includes (see instructions)
                                                                                                                 nannies but not daycare centers. 
                                                                                                                        (see instructions)

                                                                                                                      Yes                 No

                                                                                                                      Yes                 No

                                                                                                                      Yes                 No

                                 Did you receive                       No                       Complete only Part II below.
                         dependent care benefits?
                                                                       Yes                      Complete Part III on page 2 next.
Caution:  If the care provider is your household employee, you may owe employment taxes. For details, see the                               Instructions for 
Schedule H (Form 1040). If you incurred care expenses in 2022 but didn’t pay them until 2023, or if you prepaid in 2022 for care to 
be provided in 2023, don’t include these expenses in column (d) of line 2 for 2022. See the instructions.
Part II      Credit for Child and Dependent Care Expenses
 2   Information about your qualifying person(s). If you have more than three qualifying persons, see the instructions and check this box 
                                                                                                                   (c)  Check here if the   (d) Qualified expenses 
                            (a)  Qualifying person’s name                              (b)  Qualifying person’s  qualifying person was over  you incurred and paid 
                                                                                         social security number  age 12 and was disabled.    in 2022 for the person 
             First                                          Last                                                      (see instructions)          listed in column (a)  

 3   Add the amounts in column (d) of line 2. Don’t enter more than $3,000 if you had one qualifying person 
     or $6,000 if you had 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, 1040-SR, or 1040-NR, line 11                            . . .        7 
 8   Enter on line 8 the decimal amount shown below that applies to the amount on line 7.
     If line 7 is:                          If line 7 is:                                If line 7 is:
                 But not         Decimal                  But not      Decimal                        But not      Decimal  
     Over        over            amount is  Over          over         amount is         Over         over         amount is
             $0—15,000           .35        $25,000—27,000               .29             $37,000—39,000               .23
     15,000—17,000               .34        27,000—29,000                .28             39,000—41,000                .22
                                                                                                                                         8                  X .
     17,000—19,000               .33        29,000—31,000                .27             41,000—43,000                .21
     19,000—21,000               .32        31,000—33,000                .26             43,000—No limit              .20
     21,000—23,000               .31        33,000—35,000                .25
     23,000—25,000               .30        35,000—37,000                .24
 9 a Multiply line 6 by the decimal amount on line 8                 . . .   .         . .    . . .      . .     . .    .   . .    9a 
   b If you paid 2021 expenses in 2022, complete Worksheet A in the instructions. Enter the amount 
     from line 13 of the worksheet here. Otherwise, enter -0- on line 9b and go to line 9c .                            .   . .    9b
   c Add lines 9a and 9b and enter the result               .      . . . .   .         . .    . . .      . .     . .    .   . .    9c 
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 9c or line 10 here and 
     on Schedule 3 (Form 1040), line 2  .            .    . .      . . . .   .         . .    . .     .  . .     . .    .   . .    11 
For Paperwork Reduction Act Notice, see your tax return instructions.                                            Cat. No. 11862M                      Form 2441 (2022)

Form 2441 (2022)                                                                                                     Page 2
Part III   Dependent Care Benefits
12 Enter the total amount of dependent care benefits you received in 2022. Amounts you received
   as  an  employee  should  be  shown  in  box  10  of  your  Form(s)  W-2.   Don’t  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  .   . .   . . .    .  .   .  .   .   .  .   . .  .  . .   .     . . . . . .   . .         12 
13 Enter the amount, if any, you carried over from 2020 and/or 2021 and used in 2022. See instructions       13 
14 If you forfeited or carried over to 2023 any of the amounts reported on line 12 or 13, enter the
   amount. See instructions .  . .    .  .   .  .   .   .  .   . .  .  . .   .     . . . . . .   . .         14 (                                     )
15 Combine lines 12 through 14. See instructions        .  .   . .  .  . .   .     . . . . . .   . .         15 
16 Enter the total amount of qualified expenses incurred in 2022 for 
   the care of the qualifying person(s)  .   .  .   .   .  .   . .  .  .     16 
17 Enter the smaller of line 15 or 16  . .   .  .   .   .  .   . .  .  .     17 
18 Enter your earned income. See instructions  .        .  .   . .  .  .     18 
19 Enter the amount shown below that applies to you.
   • If married filing jointly, enter your spouse’s 
   earned income (if you or your spouse was a 
   student or was disabled, see the instructions 
   for line 5).                                            .   . .  .  .     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  .  .   .   .  .   . .  .  .     20 
21 Enter  $5,000  ($2,500  if  married  filing  separately and  you  were 
   required to enter your spouse’s earned income on line 19). If you
   entered  an  amount  on  line  13,  add  it  to  the  $5,000  or  $2,500 
   amount you enter on line 21. However, don enter’t    more than the 
   maximum amount allowed under your dependent care plan. If your 
   dependent  care  plan  uses  a  non-calendar  plan  year,  see 
   instructions  .  .  . .   . . .    .  .   .  .   .   .  .   . .  .  .     21 
22 Is any amount on line 12 or 13 from your sole proprietorship or partnership?
         No. Enter -0-.
         Yes. Enter the amount here . .  .   .  .   .   .  .   . .  .  . .   .     . . . . . .   . .         22 
23 Subtract line 22 from line 15 .    .  .   .  .   .   .  .   . .  .  .     23 
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    .   . .  .  . .   .     . . . . . .   . .         24 
25 Excluded benefits. 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- . . . .   . .         25
26 Taxable benefits. Subtract line 25 from line 23. If zero or less, enter -0-. Also, enter this amount 
   on Form 1040, 1040-SR, or 1040-NR, line 1e  .        .  .   . .  .  . .   .     . . . . . .   . .         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) .     .  .  . .   .     . . . . . .   . .         27 
28 Add lines 24 and 25  .    . . .    .  .   .  .   .   .  .   . .  .  . .   .     . . . . . .   . .         28 
29 Subtract line 28 from line 27. If zero or less,  stop. You can’t take the credit.   Exception. If you
   paid 2021 expenses in 2022, see the instructions for line 9b  .     . .   .     . . . . . .   . .         29 
30 Complete line 2 on page 1 of this form.   Don’t include in column (d) any benefits shown on line
   28 above. Then, add the amounts in column (d) and enter the total here  .         . . . . .   . .         30 
31 Enter the smaller of line 29 or 30. Also, enter this amount on line 3 on page 1 of this form and 
   complete lines 4 through 11 . .    .  .   .  .   .   .  .   . .  .  . .   .     . . . . . .   . .         31 
                                                                                                                Form 2441 (2022)