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Dependent Care Spending Account Worksheet

The following worksheet is provided to assist with the planning of your Dependent Care Spending Account contribution. Before making a decision, you may wish to review what you spent on dependent care last year.

First, estimate your total expenses. If you are enrolling during the open enrollment period, use the chart below to calculate your expenses for next calendar year. If you are joining the program during the year (that is, after the open enrollment period is over), use the chart to calculate your expenses for the remainder of the calendar year.

Remember, only those expenses for dependent care services that allow you and your spouse to work are eligible to be reimbursed through the DCSA.

Type of Expense	Amount per Week	X Number of Weeks/Year	= Total for Year
Child Care Provider
Child Care Center
Nursery School
Before/After School Care
Summer Day Camp
Adult Day Care Center
Disabled Dependent Care ¹
Household Services ²
Other Expenses
TOTAL ANNUAL EXPENSES (MAXIMUM AMOUNT ALLOWED BY IRS: $5,000)

IRS regulations state that whether an expense is eligible or not will depend upon the facts and circumstances of each case.

1	Disabled dependent care is eligible regardless of whether it is provided inside or outside your home, as long as the dependent resides with you at least 8 hours a day.
2	Household services, such as a cook or housekeeper, are eligible if the services are provided, in part, to a person who qualifies as a dependent and are provided to enable you and your spouse to work.

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Dependent Care Spending Account Worksheet

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