2400810053 2400810053 PA-40 DC (EX) MOD 03-24 (FI) PA Department of Revenue 2400810053 OFFICIAL USE ONLY 1. CARE PROVIDER'S NAME FULL ADDRESS OF PROVIDER SSN/FEIN ID TYPE Provide all information for each person/organization. If more than five, submit additional schedules as needed. SSN Name (if filing jointly, use name shown first on the PA-40) Social Security Number (shown first) Spouse’s Name Spouse’s Social Security Number In order to claim child and dependent care expenses, you must also claim the expenses on your Federal 1040 return. Include with the PA Schedule DC a completed copy of your federal Form 2441 and 1040 Schedule 3. You cannot claim a credit for child and dependent care expenses if your filing status is married filed separately unless you meet the requirements listed in the instructions under Eligibility Requirements. If you meet these requirements, check this oval PERSONS/ORGANIZATIONS WHO PROVIDED CARE SECTION I PA SCHEDULE DC Child and Dependent Care Enhancement Tax Credit 2024 AMOUNT PAID FEIN SSN FEIN SSN FEIN SSN FEIN SSN FEIN Provide all information about your qualifying person(s). If you have more than five qualifying persons, submit additional schedules as needed. QUALIFYING PERSON(S) TO CLAIM FOR CHILD AND DEPENDENT CARE EXPENSES SECTION II 1. QUALIFYING PERSON'S NAME FIRST NAME LAST NAME DOB (MM/DD/YYYY) SSN/ITIN RELATIONSHIP QUALIFIED EXPENSES (See instructions) INCOME AND CALCULATION OF CREDIT SECTION III 1. Enter the total number of qualifying persons from Section II from all Schedules DC. 1. 2. Enter the amount as shown on Line 9a of your federal Form 2441. Enter on your PA-40, Line 23. 2. ID TYPE SSN ITIN SSN ITIN SSN ITIN SSN ITIN SSN ITIN START § IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING PRINT NEXT PAGE TOP OF PAGE Reset Entire Form

PA-40 DC 1 revenue.pa.gov 2024 Instructions for PA-40 Schedule DC Child and Dependent Care Enhancement Tax Credit

Beginning tax year 2023, the expense amounts used to cal­ culate the credit are capped at $3,000 (one qualifying per­ son) and $6,000 (two or more qualifying persons). The credit starts at 35 percent of those expense amounts and de­ creases to 20 percent for higher income levels. The credit is 100 percent of that amount. .

PURPOSE OF SCHEDULE The purpose of the PA-40 Schedule DC, Pennsylvania Child and Dependent Care Enhancement Tax Credit is to claim a credit for child and dependent care expenses paid. Beginning tax year 2022, Pennsylvania residents who receive a credit under section 21 of the Internal Revenue Code of 1986 may claim a tax credit against their Pennsylvania tax liability. ELIGIBILITY REQUIREMENTS The Pennsylvania credit follows the requirements of section 21 of the Internal Revenue Code (IRC) and all regulations promulgated under section 21 of the IRC. In general, mar­ ried persons must file a joint return to claim the credit. If a taxpayer is married at the close of the tax year, the child and dependent care credit is allowed only if the taxpayer and spouse file a joint return. PERSONS DIVORCED OR SEPARATED An individual is not considered married if the individual is legally separated from his or her spouse under a decree of divorce or of separate maintenance. PERSONS LIVING APART You are considered unmarried for purposes of claiming the credit if your filing status is married filing separately and all of the following apply: ● you are married; ● you file a separate return; ● you maintained as your home a household that is the principal abode of a qualifying individual for more than one-half of the tax year; ● you furnished over one-half of the cost of maintaining that household during the tax year; and ● your spouse is not a member of that household during the last six months of that tax year. If you meet all of the requirements to be treated as unmar­ ried, you can generally take the credit. However, if you do not meet all of the requirements, you cannot generally take the credit. In order to claim the expenses on the PA Schedule DC, the taxpayer must also have claimed the expenses on their Fed­ eral 1040 return. IMPORTANT: A completed copy of the federal Form 2441 and the 1040 Schedule 3 must be included with the filing of the PA-40 return. Failure to include these forms will result in the credit being removed or deducted from Line 23 of the PA-40. WHO QUALIFIES In order to claim the credit on your PA-40, you must have incurred care expenses for: ● A dependent child under age 13. ● A spouse who was physically or mentally incapable of self-care and lived with you for more than half the year. ● An individual who was physically or mentally incapable of self-care, lived with you for more than half the year, and either: ° Was your dependent; or ° Could have been your dependent, except that he or she received gross income of $5,050 or more, filed a joint return, or could have been claimed as a dependent on another taxpayer's return. This credit is refundable, meaning qualified taxpayers will receive a refund of the credit in the event the credit exceeds their tax liability.

IDENTIFICATION INFORMATION Provide the name and Social Security number of the indi­ vidual shown first on the PA-40.

NAME OF CARE PROVIDER Provide the name for each care provider (up to 5). Enter the full address for each care provider (up to 5), listing the street address on the top line and the city, state, and zip code on the bottom line. SOCIAL SECURITY NUMBER OR FEIN Enter the Social Security number or Federal Employer Iden­ tification Number for each care provider listed. ID TYPE Fill in the appropriate oval to indicate if the ID provided is a SSN (Social Security number) or FEIN (Federal Employer Identification Number). WHAT’S NEW GENERAL INFORMATION FORM INSTRUCTIONS LINE INSTRUCTIONS SECTION I PA-40 DC IN 03-24 NEXT PAGE PREVIOUS PAGE

PA-40 DC 2 revenue.pa.gov AMOUNT PAID Provide the amount paid to each care provider.

Provide all information about your qualifying person(s). NAME OF QUALIFYING INDIVIDUAL(S) Enter the first and last name of each qualifying person (up to 5). DATE OF BIRTH Provide the date of birth for each qualifying person in the format of month/day/year (MM/DD/YYYY). SOCIAL SECURITY NUMBER OR ITIN Enter the Social Security number or Individual Taxpayer Identification Number for each qualifying person. If the child was born and died in 2024 and didn't have a SSN, enter "Died". ID TYPE Fill in the appropriate oval to indicate if the ID provided is a SSN (Social Security number) or ITIN (Individual Taxpayer Identification Number). If the qualifying person only has an ATIN (Adoption Taxpayer Identification Number), fill in the oval for SSN. RELATIONSHIP Provide the taxpayer’s relationship to each qualifying person listed. QUALIFIED EXPENSES Enter the amount of qualified expenses for each qualifying person per the federal Form 2441, Part II, Line 2(d).

INCOME AND CALCULATION OF CREDIT

Enter the total number of qualifying persons from Section II from all Schedules DC.

Enter the amount as shown on Line 9a of the taxpayer’s fed­ eral Form 2441. Enter the amount on Line 23 of the PA-40. Credit cannot exceed amount shown in chart on next page, based on number of dependents and amount of PA taxable income. NOTE: The expense amounts used to calculate the credit are capped at $3,000 (one qualifying person) and $6,000 (two or more qualifying persons). The credit starts at 35 percent of those expense amounts and de­ creases to 20 percent for higher income levels. The credit is 100 percent of that amount.

IMPORTANT: If you have more than 5 care providers or more than 5 qualifying persons, you must submit ad­ ditional schedules as needed. LINE 1 LINE 2 SECTION III SECTION II Household Income Over $43,000 $43,000 and under $1,050 $2,100 $1,200 $600 1 Dependent 2 or more Dependents RETURN TO FORM PREVIOUS PAGE