PLEASE read prior to completing the Dependent Care Assistance Program Registration Statement:
- A qualifying dependent for the Dependent Care Assistance Plan is a dependent child UNDER THE AGE OF 13 or a spouse or other dependent adult who’s not able to care for him or herself.
- Dependent care expenses must be utilized for the specific purpose of allowing both you and your spouse to work (unless disabled, physically or mentally incapable of self-care, attending school full-time or actively seeking employment).
- The payments for care cannot be paid to someone you can claim as your dependent on your tax return or to a child who is under age 19.
- You must be able to claim the child as an exemption on your tax return. For an exception see Section 152(e) of the Internal Revenue Code concerning dependents of divorced or separated parents or parents who live apart.
- Valid expenses include child day care, nursery school, before- and after-school care, adult care and in-home dependent care.
Tuition for Kindergarten and higher is not a valid expense.
- Internal Revenue Code Section 129 limits the maximum election amount to $5,000 ($2,500 for married filing separately) OR the employee’s earned income (if less than $5,000/$2,500) OR the spouse’s earned income (if less than $5,000/$2,500)
*Please note that claims will not be paid without a Dependent Care Registration Statement on file.
A new form must be completed each year. All sections MUST be completed.