Fillable Form .00: IT-216 Claim for Child and Dependent (New York State)

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Form .00: IT-216 Claim for Child and Dependent (New York State)

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216001200094
Department of Taxation and Finance
Claim for Child and Dependent Care Credit
New York State • New York City
Tax Law – Section 606(c)
IT-216
1 HaveyoualreadyledyourNewYorkStateincometaxreturn? ................................................................................... Yes No
If Yes,youmustleanamendedNewYorkStatereturnandincludeFormIT-216toclaimthiscredit.
3a Totalofline3,columnCamounts.Includeamountsfromadditionalsheet(s),ifany ............................ 3a
.00
3b
EntertheamountfromWorksheet1,line16,if applicable (see instr.)
3b .00
4 Canyouclaimanexemptionforallthequaliedpersonslistedonline3andanyadditionalsheet(s)?......................Yes No
5 Enterthesmallest of:
– line 3a above; or
– line 3b above; or
– 3,000ifonequalifyingperson,6,000iftwoqualifyingpersons,7,500ifthreequalifyingpersons,
8,500iffourqualifyingpersons,or9,000ifveormorequalifyingpersons .................................... 5
.00
6 Enter your earned income (see instructions) ............................................................................................ 6 .00
7 Ifyourlingstatusis Married ling joint return,enteryourspouse’searnedincome;
allothers,entertheamountfromline6
(see instructions) .................................................................... 7 .00
8 Enterthesmallestofline5,6,or7 ......................................................................................................... 8 .00
9 EntertheamountfromFormIT-201,line19aorIT-203,
line19a,Federal amount column .......................................... 9
.00
10 Enterthedecimalamountthatappliestotheamountonline9fromtheTable for line 10intheinstr. .. 10
11 Multiplyline8bythedecimalamountonline10
(enter here and on line 12 on the back) ........................... 11 .00
Whole dollars only
Name(s)asshownonreturn YourSocialSecuritynumber
Submit this form with Form IT-201 or IT-203.
2 Personsororganizationswhoprovidedthecare. (If you have more than two providers, see instructions.)
A – Care provider name (rst name, middle initial, and last name, or business name)
A – Care provider name (rst name, middle initial, and last name, or business name)
B–Numberandstreet City State ZIPcode
B–Numberandstreet City State ZIPcode
C –
Identifyingnumber(SSN or EIN)
C –
Identifyingnumber(SSN or EIN)
D – Amount paid (see instr.)
D – Amount paid (see instr.)
.00
.00
1st
Care
provider
2nd
Care
provider
3 Totalnumberofqualifyingpersonsyouareclaiming. ................................................................................................................. 3
List in order from youngest to oldest.
(If you are claiming more than ve qualifying persons, see instructions.)
A
First
name
MI
B
Last
name
C
Qualied
expensespaid
Sufx
D
Person
with
disability
(see instr.)
E
SocialSecurity
number
F
Dateofbirth
(mmddyyyy)
.00
.00
.00
.00
.00
Note:Ifyouareclaimingexpensespaidforadependentchild,includeonlythosequaliedexpensespaidthroughthedayprecedingthechild’s
13thbirthday.
216002200094
IT-216(2020)(back)
12 Amountfromline11 ............................................................................................................................... 12 .00
13 Enter your New York adjusted gross income (FormIT-201lers,
line33;FormIT-203lers,line32) ...............................................
.00
UsetheNew York State child and dependent care
credit limitation tableintheinstructionstodeterminethedecimaltobeenteredonthisline ............. 13
14 Multiplyline12bythedecimalamountonline13.ThisisyourNew York Statechildanddependent
care credit
(see instructions) .................................................................................................................. 14 .00
Part-year New York State residents
15 EntertheamountfromFormIT-203,line40 ......................................................................................... 15 .00
Ifline15isequaltoormorethanline14,stop. You do not have excess credit.
Ifline15islessthanline14,continue on line 16 below.
16 Subtractline15fromline14.This is your excess child and dependent care credit ....................... 16
.00
17 EntertheamountfromFormIT-203-ATT,line29(If you are not required to le Form IT-203-ATT, leave
blank and continue on line 18 below.) ...................................................................................................... 17 .00
Ifline17isequaltoormorethanline16,stop. Do not continue with this worksheet. Entertheline16amount
onFormIT-203-ATT,line30.
Ifline17islessthanline16,entertheline16amountonFormIT-203-ATT,line30,andcontinueonline18below.
18 Subtractline17fromline16.This is your remaining excess child and dependent care credit .... 18 .00
19 Amountfromline19,ColumnD,ofPart-year resident income allocation worksheet, inFormIT-203-I
– IfyoudidnotleFormIT-558,enterthisamount
(see instructions)
–
IfyouledFormIT-558,addtoorsubtractfromthisamountany
amountsonline2andline4ofLine 19a New York State
amount column worksheet,inFormIT-203-I(thatisrelated
toyourNYSresidentperiod),andentertheresult.(see instr.)
19 .00
20 EntertheamountfromFormIT-203,line19a,
Federal amount column ......................................................... 20
.00
21 Divideline19byline20(round the result to the fourth decimal place).
Thisamountcannotexceed100%(1.0000)
(see instructions) ............................................................... 21
22 Multiplyline18byline21.EntertheresulthereandonFormIT-203-ATT,line9.
This is the
refundable portion of your New York State part-year resident child and dependent care credit.
22 .00
New York City child and dependent care credit
IfyouwerearesidentofNewYorkCityatanytimeduringthetaxyearand yourfederaladjustedgrossincome
is$30,000orless(seeNote under New York City creditonpage1oftheinstructions)andyoulisteda
childunder
4yearsoldasofDecember31,online3,completeline23andseepage5oftheinstructions.
23 Entertheportionofthetotalexpensesfromline3athatwaspaidforchildrenunder4yearsold ........ 23 .00
  IT-201 lers:
24 RefundableNewYorkCitychildanddependentcarecredit(from Worksheet 2, line 7 or line 13) .............. 24 .00
25 Addlines14and24;alsoenterthisamountonFormIT-201,line64 .................................................... 25 .00
26 Part-yearNewYorkCityresidentnonrefundableNewYorkCitychildanddependentcarecredit
(from Worksheet 2, line 8);alsoenterthisamountonFormIT-201-ATT,line9a ................................... 26 .00
  IT-203 lers:
27 Nonrefundableportionofyourpart-yearNewYorkCityresidentNewYorkCitychildanddependent
care credit
(from Worksheet 2, line 8); alsoenterthisamountonFormIT-203,line52 ......................... 27 .00
28 Refundableportionofyourpart-yearNewYorkCityresidentNewYorkCitychildanddependent
care credit
(from Worksheet 2, line 13); alsoenterthisamountonFormIT-203-ATT,line9a ................ 28 .00
  Part-year New York City resident lers only:
29 EntertheamountfromWorksheet2,line10 ......................................................................................... 29 .00
30 EntertheamountfromWorksheet2,line11 ......................................................................................... 30 .00
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Form .00: IT-216 Claim for Child and Dependent (New York State)

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Completed 6 May 2021

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