Child/Dependent Care Expense Worksheet

When figuring child or dependent care expenses remember to exclude vacation weeks or other days when you may not be paying for care.

If care expenses change regularly you must average the dollars for the entire Plan Year

Preschool Child Care Expenses:
Fixed Child Care Expenses:	$ / week * = $
Anticipated Increase or Decrease in Care Expenses:	$ / week * = $
	Total Plan Year Care Expenses:
School Age Child Care Expenses: (Must be under age 13)
Before and After School Care Expenses:	$ / week * = $
School Vacation and Summer Care Expenses: (excluding overnight camp)	$ / week * = $
	Total Plan Year Care Expenses:
Dependent Care Expenses: Eligible expenses are for an older dependent or spouse who is claimed on your tax return, lives in your house 8 hours each day and has a physical or mental handicap requiring care.
Fixed Care Expenses:	$ / week * = $
Anticipated Increase or Decrease in Care Expenses:	$ / week * = $
	Total Plan Year Care Expenses:

Total Plan Year Care Expenses

Preschool Child Care Expenses $ per plan year

School Age Child Care Expenses $ per plan year

Dependent Child Care Expenses $ per plan year

$Total Expenses

Total Expenses $ divided by # pay periods in plan year=$ per pay period

REMEMBER !
THE MAXIMUM DEDUCTION PER FAMILY PER YEAR IS $5000 REGARDLESS OF THE NUMBER OF WAGE EARNERS!!

Total Plan Year Care Expenses
Preschool Child Care Expenses	$ per plan year
School Age Child Care Expenses	$ per plan year
Dependent Child Care Expenses	$ per plan year
	$Total Expenses