Dependent Care Due Diligence Form
This form is being used if you paid a person or organization to provide care for your dependent who is under the age of 13 while you worked or actively looked for work. If your dependent is over the age of 13 in order to qualify for this credit, the individual must be totally and permanently disabled.
Name of Dependent Who Care Was Provided for
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Age of Dependent
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Name of person or organization who kept your dependent
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Full Address of the person or organization who provided care for your dependent
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EIN/Social Security Number (if an individual provided care for your child, a social security number is required) (If a tax exempt organization provided care such as a church or non-profit organization, no EIN is required). (If a for profit organization provided care, an EIN is required). If exempt, type NA
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Full Amount Paid for ChildCare
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By signing this form, you understand that this information is being provided to the IRS. In case of an audit, you may have to provide written proof of the requested information.
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Submit
Should be Empty: