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Information about Form 2441 and its separate instructions is at irs.gov/form2441. 2013. Attachment. Sequence No. 21. Name(s) shown on return. Back to Expanded Instructions Index Only one of the following two credits may be taken: You must include a copy of your completed federal form 2441. 2013 estimated tax payments and amount applied from 2012 return Information about Form 2441 and its separate instructions is at irs.gov/form2441. (If you have more than two providers, see instructions.) A – Care provider's first name, federal Form 2441, line 3; or IT-216 (2013) (back). File Form 2441N ONLY if your adjusted gross income is $29,000 or less, and you are claiming the. Nebraska refundable child and dependent care credit. Other Non-Refundable Credits (See Instructions). (Must attach Form 2441.) 2013. To. Filing Status 4 ONLY All other filing statuses. Instructions for Form 2441 Child and Dependent Care Expenses 2021Instructions for Form 2441Department of the Treasury Internal Revenue ServiceChild and. Payment made with extension: (See Instructions) (20% of federal credit; Attach federal Form 2441