This form contains 75 fields organized into 11 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Information
topmostSubform[0].Page2[0].f2_12[0 Text
Enter any additional information or comments related to the form.
Max length: 50 characters
Calculations
24 24 Text
Enter the amount for line 24 as specified in the form instructions.
Max length: 50 characters
25 25 Excluded benefits. If you checked “No” on line 22, enter the smaller of line 20 or line 21 Text
Enter the excluded benefits amount. If you checked 'No' on line 22, enter the smaller of line 20 or line 21.
Max length: 50 characters
26 36 Text
Enter the amount for line 26 as specified in the form instructions.
27 27 Enter $3,000 ($6,000 if two or more qualifying persons) Text
Enter $3,000 if you have one qualifying person, or $6,000 if you have two or more qualifying persons.
Max length: 50 characters
e91f Add lines 24 and 25 28 28 Text
Add the amounts from lines 24 and 25 and enter the total here.
Max length: 50 characters
29 Text
Enter the amount for line 29 as specified in the form instructions.
Max length: 50 characters
30 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 Text
Complete line 2 on page 1 of this form. Do not include in column (d) any benefits shown on line 28 above. Then, add the amounts in column (d) and enter the total here.
Max length: 50 characters
34 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 31 Text
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.
Max length: 50 characters
Care Provider Information
topmostSubform[0].Page1[0].PartITable[0].BodyRow1[0].f1_3[0 Text
Enter the name of the care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow1[0].ColB[0].f1_4[0 Text
Enter the address of the care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow1[0].ColB[0].f1_5[0 Text
Enter the city, state, and ZIP code of the care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow1[0].f1_6[0 Text
Enter the care provider's social security number or employer identification number. This should be exactly 11 characters long, including dashes.
Max length: 11 characters
topmostSubform[0].Page1[0].PartITable[0].BodyRow1[0].ColD[0].c1_4[0]_1 CheckBox
Check this box if the care provider is a household employee.
topmostSubform[0].Page1[0].PartITable[0].BodyRow1[0].ColD[0].c1_4[1]_2 CheckBox
Check this box if the care provider is not a household employee.
topmostSubform[0].Page1[0].PartITable[0].BodyRow1[0].f1_7[0 Text
Enter the name of the first care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow2[0].f1_8[0 Text
Enter the address of the first care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow2[0].ColB[0].f1_9[0 Text
Enter the identification number (EIN or SSN) of the first care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow2[0].ColB[0].f1_10[0 Text
Enter the amount paid to the first care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow2[0].f1_11[0 Text
Enter the name of the second care provider.
Max length: 11 characters
topmostSubform[0].Page1[0].PartITable[0].BodyRow2[0].ColD[0].c1_5[0]_1 CheckBox
Check this box if the second care provider is a tax-exempt organization.
topmostSubform[0].Page1[0].PartITable[0].BodyRow2[0].ColD[0].c1_5[1]_2 CheckBox
Check this box if the second care provider is not a tax-exempt organization.
topmostSubform[0].Page1[0].PartITable[0].BodyRow2[0].f1_12[0 Text
Enter the address of the second care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow3[0].f1_13[0 Text
Enter the identification number (EIN or SSN) of the second care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow3[0].ColB[0].f1_14[0 Text
Enter the amount paid to the second care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow3[0].ColB[0].f1_15[0 Text
Enter the name of the care provider.
topmostSubform[0].Page1[0].PartITable[0].BodyRow3[0].f1_16[0 Text
Enter the care provider's identification number (EIN or SSN).
Max length: 11 characters
topmostSubform[0].Page1[0].PartITable[0].BodyRow3[0].ColD[0].c1_6[0]_1 CheckBox
Check this box if the care provider is a household employee.
topmostSubform[0].Page1[0].PartITable[0].BodyRow3[0].ColD[0].c1_6[1]_2 CheckBox
Check this box if the care provider is a business.
topmostSubform[0].Page1[0].PartITable[0].BodyRow3[0].f1_17[0 Text
Enter the address of the care provider.
topmostSubform[0].Page1[0].Table_Line2[0].Row1[0].f1_21[0 Text
Enter the name of the first care provider.
topmostSubform[0].Page1[0].Table_Line2[0].Row2[0].f1_22[0 Text
Enter the address of the first care provider.
topmostSubform[0].Page1[0].Table_Line2[0].Row2[0].f1_23[0 Text
Enter the identification number (EIN or SSN) of the first care provider.
topmostSubform[0].Page1[0].Table_Line2[0].Row2[0].f1_24[0 Text
Enter the amount paid to the first care provider. Maximum length is 11 characters.
Max length: 11 characters
topmostSubform[0].Page1[0].Table_Line2[0].Row2[0].c1_9[0]_1 CheckBox
Check this box if the first care provider is a household employer.
topmostSubform[0].Page1[0].Table_Line2[0].Row2[0].f1_25[0 Text
Enter the name of the second care provider.
topmostSubform[0].Page1[0].Table_Line2[0].Row3[0].f1_26[0 Text
Enter the address of the second care provider.
topmostSubform[0].Page1[0].Table_Line2[0].Row3[0].f1_27[0 Text
Enter the identification number (EIN or SSN) of the second care provider.
topmostSubform[0].Page1[0].Table_Line2[0].Row3[0].f1_28[0 Text
Enter the amount paid to the second care provider. Maximum length is 11 characters.
Max length: 11 characters
topmostSubform[0].Page1[0].Table_Line2[0].Row3[0].c1_10[0]_1 CheckBox
Check this box if the second care provider is a household employer.
topmostSubform[0].Page1[0].Table_Line2[0].Row3[0].f1_29[0 Text
Enter the name of the care provider.
topmostSubform[0].Page2[0].f2_2[0 Text
Enter the name of the care provider.
Max length: 50 characters
topmostSubform[0].Page2[0].f2_3[0 Text
Enter the address of the care provider.
topmostSubform[0].Page2[0].f2_4[0 Text
Enter the identification number (EIN or SSN) of the care provider.
Max length: 50 characters
Credit Calculation
22 Text
Enter the total amount of child and dependent care credit.
Max length: 50 characters
Dependent Care Benefits
topmostSubform[0].Page1[0].c1_7[0]_1 CheckBox
Check this box if you received dependent care benefits.
11 Text
Enter the total amount of dependent care benefits received.
Max length: 50 characters
topmostSubform[0].Page2[0].f2_1[0 Text
Enter the total amount of dependent care benefits received.
Max length: 50 characters
topmostSubform[0].Page2[0].f2_7[0 Text
Enter the amount of dependent care benefits received.
Max length: 50 characters
Filing Status
topmostSubform[0].Page2[0].c2_1[0]_1 CheckBox
Check this box if you are married and filing a joint return.
topmostSubform[0].Page2[0].c2_1[1]_2 CheckBox
Check this box if you are single, head of household, or qualifying widow(er).
General Information
topmostSubform[0].Page1[0].c1_1[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
topmostSubform[0].Page1[0].PartI[0].c1_3[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions.
Income Information
3 4 4 or $6,000 if you had two or more persons. If you completed Part III, enter the amount from line 31 Enter your earned income. See instructions Text
Enter your earned income. Refer to the instructions for more details.
Max length: 50 characters
topmostSubform[0].Page1[0].f1_31[0 Text
Enter the amount from line 31 if you completed Part III.
Max length: 50 characters
or was disabled, see the instructions); all others, enter the amount from line 4 Text
Enter the amount from line 4 if the person was disabled. Refer to the instructions for more details.
Max length: 50 characters
or was disabled, see the instructions); all others, enter the amount from line 4 dbd4 56 6 Text
Enter the amount from line 4 if the person was disabled. Refer to the instructions for more details.
Max length: 50 characters
topmostSubform[0].Page2[0].f2_8[0 Text
Enter the amount of earned income for the taxpayer.
Max length: 50 characters
Qualifying Expenses
16 Enter the total amount of qualified expenses incurred in 2023 for the care of the qualifying person(s) 16 Text
Enter the total amount of qualified expenses incurred in 2023 for the care of the qualifying person(s).
Max length: 50 characters
17 Enter the smaller of line 15 or 16 17 Text
Enter the smaller amount between line 15 or line 16.
Max length: 50 characters
20 Enter the smallest of line 17, 18, or 19 20 Text
Enter the smallest amount between line 17, line 18, or line 19.
Max length: 50 characters
20 Enter the smallest of line 17, 18, or 19 20 8ce7 220 Text
Enter the smallest amount between line 17, line 18, or line 19.
Max length: 50 characters
Qualifying Person Information
topmostSubform[0].Page1[0].Table_Line2[0].Row1[0].f1_18[0 Text
Enter the name of the qualifying person for whom the care was provided.
topmostSubform[0].Page1[0].Table_Line2[0].Row1[0].f1_19[0 Text
Enter the Social Security Number (SSN) of the qualifying person.
topmostSubform[0].Page1[0].Table_Line2[0].Row1[0].f1_20[0 Text
Enter the amount of qualified expenses you incurred and paid in 2023 for the qualifying person.
Max length: 11 characters
topmostSubform[0].Page1[0].Table_Line2[0].Row1[0].c1_8[0]_1 CheckBox
Check this box if the qualifying person is a child under the age of 13.
topmostSubform[0].Page1[0].f1_34[0 Text
Enter the name of the qualifying person.
topmostSubform[0].Page1[0].f1_35[0 Text
Enter the age of the qualifying person.
Max length: 2 characters
9a Text
Enter the Social Security Number (SSN) of the qualifying person.
Max length: 50 characters
topmostSubform[0].Page1[0].f1_37[0 Text
Enter the Social Security Number (SSN) of the qualifying person.
Max length: 50 characters
9c Text
Enter the Social Security Number (SSN) of the qualifying person.
Max length: 50 characters
topmostSubform[0].Page1[0].f1_39[0 Text
Enter the name of the qualifying person.
Taxpayer Information
Name(s) shown on return Text
Enter the name(s) exactly as shown on your tax return (Form 1040, 1040-SR, or 1040-NR).
Your social security number Text
Enter your social security number. This should be exactly 11 characters long, including dashes.
Max length: 11 characters