DCAAccount Contribution Worksheet


To help you plan the amount of your DCAAccount contribution, use this worksheet. You may want to look at what you spent for dependent care last year before making your decision.

Remember: Only those expenses for dependent care services that allow you and your spouse to work are eligible to be reimbursed through the DCAAccount.

First, estimate your total expenses for 2000. If you are enrolling during the open enrollment period, use the chart below to calculate your expenses for the entire year. If you are joining the program during the year (i.e., after the open enrollment period is over), use the chart to calculate your expenses for the remainder of the calendar year.


TYPE OF EXPENSE Amount
Per Week
Number of
Weeks/Year
Total for
Year
Baby Sitter X =
Child Care Center X =
Nursery School X =
Kindergarten1 X =
Before/After School Care X =
Summer Day Camp X =
Adult Day Care Center X =
Disabled Dependent Care2 X =
Household Services3 X =
Transportation Services4 X =
Other Expenses X =
Total Annual Expenses (Enter this amount, or a lower amount, on your enrollment form as your annual election amount. Maximum amount allowed by the IRS is $ 5000.)

To determine your biweekly deduction, divide your annual deduction by the number of paychecks you normally receive in a year minus the first and last paychecks of 2000.

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


1 Kindergarten is eligible if primary use is for care.

2 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.

3 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.

4 Transportation costs may be reimbursable expenses, if the services are needed to transport your dependent to his/her care provider (e.g., bus or van services, or other contractual arrangements) and the costs are paid to the care provider.

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