Form 2441n - Nebraska Child And Dependent Care Expenses - 2014 Page 2
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5FORM 2441N
Dependent Care Benefits
2014
Name as Shown on Form 1040N
Social Security Number
Part III — Dependent Care Benefits
14 Enter the total amount of dependent care benefits you received in 2014. Amounts you
received as an employee should be shown in box 10 of your Federal Form W-2, but do not include
amounts reported as wages in box 1 of Form W-2. If you were self-employed or a partner in a
partnership, include amounts you received under a dependent care assistance program from your
sole proprietorship or partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Enter the amount, if any, you carried over from 2013 and used in 2014 during the grace period
(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Enter the amount forfeited or carried forward to 2015, if any (see instructions) . . . . . . . . . . . . . . . . . . . 16
17 Subtract line 16 from total of line 14 and line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Enter the total amount of qualified expenses incurred in 2014 for the care
of the qualifying persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Enter the smaller of line 17 or 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Enter your earned income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Enter the amount shown below that applies to you:
• If married, filing jointly, enter your spouse’s earned income (if your spouse
was a student or was disabled, see instructions);
• If married, filing separately, see instructions for the amount to enter; or
• All others, enter the amount from line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Enter the smallest of line 19, 20, or 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Enter $5,000 (or enter $2,500 if married, filing separately, and you were required to enter your
spouse’s earned income on line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Enter the amount from line 14 that you received from your sole proprietorship or partnership.
If you did not receive any such amounts, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
25 Subtract line 24 from line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Deductible benefits. Enter the smallest of line 22, 23, or 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27 Enter the smaller of line 22 or 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
28 Enter the amount from line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
29 Excluded benefits. Subtract line 28 from line 27. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . 29
30 Taxable benefits. Subtract line 29 from line 25. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . 30
To claim the child and dependent care credit, complete lines 31-35 below.
31 Enter $3,000 (or enter $6,000 if two or more qualifying persons) . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
32 Add lines 26 and 29 and enter result here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 Subtract line 32 from line 31. If zero or less, stop. You cannot take the credit.
Exception: If you paid 2013 expenses in 2014, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
34 Complete line 2 on the front of this form. Do not include in Column (C) any benefits shown on
line 32 above. Then, add the amounts in Column (C) and enter the total here . . . . . . . . . . . . . . . . . 34
35 Enter the smaller of line 33 or 34. Also, enter this amount on line 3 on the front of this form and
complete lines 4-12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
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