[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-304262-105":53,"doc-detail-304262-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","dependent-care-worksheet-flexible-spending","Dependent Care Worksheet - Flexible Spending","","Flexible Spending Dependent Care Worksheet helps estimate contributions to a Dependent Care Assistance Account for pre-tax payment of qualifying dependent care expenses. It defines qualifying expenses, eligible dependents under age 13, and special rules for dependents over 13 and for mentally or physically unable individuals. The worksheet provides guidance on estimating total expenses across pay periods, calculating per-pay-period deductions, submitting claims to EBS, and understanding limits and reimbursement behavior. It also contrasts the dependent care account with available tax credits.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/dependent-care-worksheet-flexible-spending/304262/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/dependent-care-worksheet-flexible-spending/304262.png","ImageObject",442,249,{"name":88,"@type":89},"Oliver","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-02","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the Dependent Care Assistance Account used for?","Question",{"text":108,"@type":109},"It lets you set aside money from your paycheck on a pre-tax basis to pay for qualifying dependent care expenses so you (or you and your spouse) can work.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Which expenses generally qualify under the worksheet’s Dependent Care rules?",{"text":113,"@type":109},"Qualifying expenses must enable employment or full-time school/active job seeking. Care providers can include relatives in certain conditions, and education, food, clothing, and transportation generally do not qualify except when incidental to inseparable care.",{"name":115,"@type":106,"acceptedAnswer":116},"What happens if your claim exceeds your remaining account balance?",{"text":117,"@type":109},"You will only receive reimbursement up to the available contributions remaining in your account. Any remaining balance stays on the account and can be paid as additional deposits are made.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},304262,1790312493,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":73},8796095461610,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Flexible Spending  \nDependent Care Worksheet  \nThis worksheet has been prepared to help you estimate how much you would like to allocate to the Dependent Care Assistance Account. This account allows you to set aside money from your paycheck, on a pre-tax basis, to pay for qualifying care expenses so that you, or you and your spouse, may work.  \nDetermining Qualifying Expenses:  \n􀂙 The expense you incur for dependent care must enable you, or you and your spouse, to be employed (or your spouse to go to school full time, or actively seek employment) .  \n􀂙 The services may be provided in your home, or at another location.  \n􀂙 The care provider does not have to be licensed, they can be a relative as long as they are not your minor child, or your dependent, for income tax purposes (over age 18) .  \n􀂙 Childcare expenses qualify for the care of children under the age of 13 , and the child must be your dependent for tax purposes. (Note: if the child turns 13 during the plan year, reimbursements for the period after attaining age 13 will not qualify.)  \n􀂙 Care expenses for dependents over the age of 13 , only qualify if your dependent spends at least 8 hours a day in your home and has special care needs. (mentally or physically challenged)  \n􀂙 If the services are provided by a day care facility that cares for 6 or more children at the sametime, the facility must comply with the state and local regulations for day care centers. The facility must be licensed only if state or locally required.  \n􀂙 Care providers will have to provide a license number or social security number (this includes relatives) . You will be required to file an IRS form (2441 and/or W10) with your annual tax return with this information.  \n􀂙 Services must be for the physical care of the child; expenses for food, clothing, transportation and education do not qualify under this definition, however, such expenses are reimbursable if they are incidental to or an inseparable part of the care provided.  \nQualified Dependents  \n• a dependent child of the taxpayer who is under age 13  \n• a spouse or dependent of the taxpayer, regardless of age, who is mentally or physically unable to care for himself or herself.  \n􀂙 In the case of parents who are divorced or legally separated or who have a written separation agreement, a child can be a qualifying individual only with respect to the parent who has custody of the child for a longer period during the calendar year than the other parent.  \n􀂙 To qualify as being mentally or physically incapable of self-care, an individual must have a mental or physical defect that renders the individual unable to care for his or her hygiene or nutritional needs , or requires that the individual have the full-time attention of another person to ensure his or her safety or the safety of others. It is not sufficient that the individual simply have defects making it impossible to hold a job or perform the usual functions of a homemaker.  \nEstimating Expenses  \nEstimate conservatively, if you do not incur the total amount you deposited to this account during the plan year, that amount will not be reimbursed to you. You cannot use those funds for any other services or for any other plan year.  \nTotal estimated dependent care expenses for plan year:$   \nNumber of pay periods (i. e. monthly=12, semi-monthly=24, bi-weekly=26)  \n__________  \nDivide: Total estimated expenses by number of pay periods for per pay period deduction:$   \n(For example: estimated expenses are $5000, number of pay periods is 26, per pay period deduction would be $192 . 30)  \nMaking Changes  \nGenerally, changes to this plan are only allowed if you have a “ change in family status” , however there are certain situations in which a change may qualify. If you have a question about whether or not you can make a change, you may contact EBS Customer Service for assistance.  \nClaims  \nYou may submit your claims to EBS as often as you like for reimbursement. You will not receive reimburseme","cbCaikp8g9gPNDGg","https://ap.wps.com/l/cbCaikp8g9gPNDGg","pdf",189630,"English","# Determining Qualifying Expenses\n## Qualified Dependents\n## Estimating Expenses\n## Making Changes\n## Claims\n## Reimbursement vs. Tax Credit","[{\"question\":\"What is the Dependent Care Assistance Account used for?\",\"answer\":\"It lets you set aside money from your paycheck on a pre-tax basis to pay for qualifying dependent care expenses so you (or you and your spouse) can work.\"},{\"question\":\"Which expenses generally qualify under the worksheet’s Dependent Care rules?\",\"answer\":\"Qualifying expenses must enable employment or full-time school/active job seeking. Care providers can include relatives in certain conditions, and education, food, clothing, and transportation generally do not qualify except when incidental to inseparable care.\"},{\"question\":\"What happens if your claim exceeds your remaining account balance?\",\"answer\":\"You will only receive reimbursement up to the available contributions remaining in your account. Any remaining balance stays on the account and can be paid as additional deposits are made.\"}]","Dependent Care Worksheet - Flexible Spending | PDF",1789811507]