{"formImage":{"Transcoder":"pdf2json@0.6.8","Agency":"","Id":{"AgencyId":"unknown","Name":"unknown","MC":false,"Max":-1,"Parent":-1},"Pages":[{"Height":49.5,"HLines":[{"x":50.957,"y":19.455,"w":0.75,"l":48.177},{"x":50.957,"y":8.986,"w":0.75,"l":48.177},{"dsh":1,"x":53.177,"y":18.862,"w":1.125,"l":43.684},{"dsh":1,"x":52.922,"y":9.615,"w":1.125,"l":43.684},{"x":6.316,"y":5.237,"w":2.25,"l":92.606},{"x":6.316,"y":2.278,"w":2.25,"l":92.606},{"x":44.655,"y":14.98,"w":0.75,"l":4.802},{"x":44.655,"y":14.228,"w":0.75,"l":4.802},{"x":44.655,"y":19.494,"w":0.75,"l":4.802},{"x":44.655,"y":18.742,"w":0.75,"l":4.802},{"x":6.239,"y":20.16,"w":0.501,"l":92.813},{"x":6.239,"y":20.264,"w":0.501,"l":92.813},{"x":85.476,"y":33.791,"w":0.75,"l":13.543},{"x":85.476,"y":33.048,"w":0.75,"l":13.543},{"x":6.188,"y":39.706,"w":0.75,"l":92.813},{"x":6.188,"y":36.7,"w":0.75,"l":92.813},{"x":6.188,"y":37.452,"w":0.75,"l":92.813},{"x":6.188,"y":38.203,"w":0.75,"l":92.813},{"x":6.188,"y":38.955,"w":0.75,"l":92.813},{"x":44.655,"y":18.737,"w":0.75,"l":4.802},{"x":44.655,"y":17.985,"w":0.75,"l":4.802},{"x":6.188,"y":34.583,"w":0.501,"l":92.813},{"x":6.188,"y":34.687,"w":0.501,"l":92.813},{"x":6.188,"y":6.734,"w":0.75,"l":92.813},{"x":6.188,"y":8.22,"w":0.75,"l":92.813},{"x":6.188,"y":24.742,"w":0.75,"l":92.813},{"x":85.476,"y":24.745,"w":0.75,"l":13.543},{"x":85.476,"y":24.002,"w":0.75,"l":13.543},{"x":6.23,"y":24.745,"w":0.75,"l":55.602},{"x":6.23,"y":22.526,"w":0.75,"l":55.602},{"x":63.217,"y":24.746,"w":0.75,"l":14.764},{"x":63.217,"y":24.004,"w":0.75,"l":14.764},{"x":6.188,"y":41.094,"w":0.501,"l":92.813},{"x":6.188,"y":41.199,"w":0.501,"l":92.813},{"x":88.218,"y":44.813,"w":0.75,"l":10.479},{"x":88.218,"y":44.062,"w":0.75,"l":10.479},{"x":87.936,"y":42.568,"w":0.75,"l":11.02},{"x":87.936,"y":41.816,"w":0.75,"l":11.02},{"x":87.936,"y":43.32,"w":0.75,"l":11.02},{"x":87.936,"y":42.568,"w":0.75,"l":11.02},{"x":87.967,"y":46.326,"w":0.75,"l":10.99},{"x":87.967,"y":45.574,"w":0.75,"l":10.99},{"x":6.239,"y":46.601,"w":0.501,"l":92.813},{"x":6.239,"y":46.705,"w":0.501,"l":92.813},{"x":44.642,"y":11.972,"w":0.75,"l":4.802},{"x":44.642,"y":11.221,"w":0.75,"l":4.802},{"x":44.655,"y":14.222,"w":0.75,"l":4.802},{"x":44.655,"y":13.471,"w":0.75,"l":4.802},{"x":6.188,"y":28.533,"w":0.75,"l":92.813},{"x":85.476,"y":28.536,"w":0.75,"l":13.543},{"x":85.476,"y":27.793,"w":0.75,"l":13.543},{"x":6.23,"y":28.536,"w":0.75,"l":55.602},{"x":6.23,"y":26.318,"w":0.75,"l":55.602},{"x":63.217,"y":28.538,"w":0.75,"l":14.764},{"x":63.217,"y":27.795,"w":0.75,"l":14.764},{"x":6.188,"y":32.283,"w":0.75,"l":92.813},{"x":85.476,"y":32.286,"w":0.75,"l":13.543},{"x":85.476,"y":31.543,"w":0.75,"l":13.543},{"x":6.23,"y":32.286,"w":0.75,"l":55.602},{"x":6.23,"y":30.068,"w":0.75,"l":55.602},{"x":63.217,"y":32.288,"w":0.75,"l":14.764},{"x":63.217,"y":31.545,"w":0.75,"l":14.764}],"VLines":[{"x":99.134,"y":8.986,"w":0.75,"l":10.469},{"x":50.957,"y":8.986,"w":0.75,"l":10.469},{"dsh":1,"x":52.411,"y":9.892,"w":1.125,"l":8.785},{"dsh":1,"x":97.372,"y":9.8,"w":1.125,"l":8.785},{"x":98.923,"y":2.278,"w":2.25,"l":2.959},{"x":6.316,"y":2.278,"w":2.25,"l":2.959},{"x":49.457,"y":14.228,"w":0.75,"l":0.752},{"x":44.655,"y":14.228,"w":0.75,"l":0.752},{"x":49.457,"y":18.742,"w":0.75,"l":0.752},{"x":44.655,"y":18.742,"w":0.75,"l":0.752},{"x":99.019,"y":33.048,"w":0.75,"l":0.743},{"x":85.476,"y":33.048,"w":0.75,"l":0.743},{"x":85.465,"y":34.652,"w":0.75,"l":6.353},{"x":42.565,"y":34.693,"w":0.75,"l":5.009},{"x":56.366,"y":34.693,"w":0.75,"l":5.025},{"x":68.679,"y":34.693,"w":0.75,"l":5.009},{"x":49.457,"y":17.985,"w":0.75,"l":0.752},{"x":44.655,"y":17.985,"w":0.75,"l":0.752},{"x":37.082,"y":5.242,"w":0.75,"l":1.478},{"x":37.082,"y":6.728,"w":0.75,"l":1.478},{"x":61.746,"y":5.242,"w":0.75,"l":1.478},{"x":61.746,"y":6.728,"w":0.75,"l":1.478},{"x":80.48,"y":5.242,"w":0.75,"l":1.478},{"x":80.48,"y":6.728,"w":0.75,"l":1.478},{"x":99.019,"y":24.002,"w":0.75,"l":0.743},{"x":85.476,"y":24.002,"w":0.75,"l":0.743},{"x":61.832,"y":22.526,"w":0.75,"l":2.219},{"x":6.23,"y":22.526,"w":0.75,"l":2.219},{"x":77.981,"y":24.004,"w":0.75,"l":0.743},{"x":63.217,"y":24.004,"w":0.75,"l":0.743},{"x":98.696,"y":44.062,"w":0.75,"l":0.752},{"x":88.218,"y":44.062,"w":0.75,"l":0.752},{"x":98.957,"y":41.816,"w":0.75,"l":0.752},{"x":87.936,"y":41.816,"w":0.75,"l":0.752},{"x":98.957,"y":42.568,"w":0.75,"l":0.752},{"x":87.936,"y":42.568,"w":0.75,"l":0.752},{"x":98.957,"y":45.574,"w":0.75,"l":0.752},{"x":87.967,"y":45.574,"w":0.75,"l":0.752},{"x":49.445,"y":11.221,"w":0.75,"l":0.752},{"x":44.642,"y":11.221,"w":0.75,"l":0.752},{"x":49.457,"y":13.471,"w":0.75,"l":0.752},{"x":44.655,"y":13.471,"w":0.75,"l":0.752},{"x":6.23,"y":4.538,"w":0.75,"l":2.181},{"x":6.23,"y":6.023,"w":0.75,"l":2.181},{"x":99.012,"y":5.288,"w":0.75,"l":1.462},{"x":99.012,"y":6.773,"w":0.75,"l":1.462},{"x":99.019,"y":27.793,"w":0.75,"l":0.743},{"x":85.476,"y":27.793,"w":0.75,"l":0.743},{"x":61.832,"y":26.318,"w":0.75,"l":2.219},{"x":6.23,"y":26.318,"w":0.75,"l":2.219},{"x":77.981,"y":27.795,"w":0.75,"l":0.743},{"x":63.217,"y":27.795,"w":0.75,"l":0.743},{"x":99.019,"y":31.543,"w":0.75,"l":0.743},{"x":85.476,"y":31.543,"w":0.75,"l":0.743},{"x":61.832,"y":30.068,"w":0.75,"l":2.219},{"x":6.23,"y":30.068,"w":0.75,"l":2.219},{"x":77.981,"y":31.545,"w":0.75,"l":0.743},{"x":63.217,"y":31.545,"w":0.75,"l":0.743}],"Fills":[{"x":0,"y":0,"w":0,"h":0,"clr":1}],"Texts":[{"x":8.344,"y":46.734,"w":507.83000000000015,"clr":0,"A":"left","R":[{"T":"%E2%80%94YOU%20MUST%20INCLUDE%20THIS%20SCHEDULE%20WITH%20YOUR%20OREGON%20TAX%20RETURN%20TO%20RECEIVE%20THIS%20CREDIT%20%E2%80%94","S":-1,"TS":[0,13,0,0]}]},{"x":5.972,"y":9.702,"w":13.071000000000002,"clr":0,"A":"left","R":[{"T":"Household%20Size%20Calculation","S":3,"TS":[0,12,0,0]}]},{"x":6.681,"y":10.452,"w":0.8340000000000001,"clr":0,"A":"left","R":[{"T":"1.","S":-1,"TS":[0,11,0,0]}]},{"x":8.447,"y":10.452,"w":15.209000000000001,"clr":0,"A":"left","R":[{"T":"Enter%20the%20number%20of%20exemptions%20%20%20","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.447,"y":11.202,"w":15.299,"clr":0,"A":"left","R":[{"T":"you%20claimed%20on%20your%20federal%20return","S":-1,"TS":[0,11.5,0,0]}]},{"x":31.153,"y":11.202,"w":7.784000000000006,"clr":0,"A":"left","R":[{"T":"............................","S":-1,"TS":[0,11.5,0,0]}]},{"x":42.801,"y":11.202,"w":0.556,"clr":0,"A":"left","R":[{"T":"1","S":-1,"TS":[0,11.5,0,0]}]},{"x":6.61,"y":11.952,"w":0.8340000000000001,"clr":0,"A":"left","R":[{"T":"2.","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.448,"y":11.952,"w":19.970000000000002,"clr":0,"A":"left","R":[{"T":"Enter%20the%20number%20of%20exemptions%20you%20did%20not%20","S":-1,"TS":[0,11.5,0,0]}]},{"x":35.216,"y":13.452,"w":5.004000000000001,"clr":0,"A":"left","R":[{"T":"..................","S":-1,"TS":[0,11.5,0,0]}]},{"x":42.802,"y":13.452,"w":0.556,"clr":0,"A":"left","R":[{"T":"2","S":-1,"TS":[0,11.5,0,0]}]},{"x":6.612,"y":14.202,"w":0.8340000000000001,"clr":0,"A":"left","R":[{"T":"3.","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.45,"y":14.202,"w":7.781,"clr":0,"A":"left","R":[{"T":"Add%20lines%201%20and%202","S":-1,"TS":[0,11.5,0,0]}]},{"x":20.19,"y":14.202,"w":15.290000000000019,"clr":0,"A":"left","R":[{"T":".......................................................","S":-1,"TS":[0,11.5,0,0]}]},{"x":42.804,"y":14.202,"w":0.556,"clr":0,"A":"left","R":[{"T":"3","S":-1,"TS":[0,11.5,0,0]}]},{"x":6.613,"y":14.952,"w":0.8340000000000001,"clr":0,"A":"left","R":[{"T":"4.","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.451,"y":14.952,"w":23.711000000000002,"clr":0,"A":"left","R":[{"T":"Enter%20the%20number%20of%20exemptions%20you%20claimed%20on%20your","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.451,"y":16.453,"w":24.433000000000003,"clr":0,"A":"left","R":[{"T":"household%20during%202013%2C%20including%20exemptions%20released","S":-1,"TS":[0,11.5,0,0]}]},{"x":37.655,"y":17.953,"w":3.3360000000000003,"clr":0,"A":"left","R":[{"T":"............","S":-1,"TS":[0,11.5,0,0]}]},{"x":42.805,"y":17.953,"w":0.556,"clr":0,"A":"left","R":[{"T":"4","S":-1,"TS":[0,11.5,0,0]}]},{"x":6.615,"y":18.703,"w":0.8340000000000001,"clr":0,"A":"left","R":[{"T":"5.","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.453,"y":18.703,"w":15.726000000000003,"clr":0,"A":"left","R":[{"T":"Household%20size.%20Line%203%20minus%20line%204","S":-1,"TS":[0,11.5,0,0]}]},{"x":31.565,"y":18.703,"w":7.506000000000006,"clr":0,"A":"left","R":[{"T":"...........................","S":-1,"TS":[0,11.5,0,0]}]},{"x":42.807,"y":18.703,"w":0.556,"clr":0,"A":"left","R":[{"T":"5","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.17,"y":2.758,"w":4.982000000000001,"clr":0,"A":"left","R":[{"T":"Schedule%20%20","S":-1,"TS":[0,23,0,0]}]},{"x":11.862,"y":4.133,"w":2.556,"clr":0,"A":"left","R":[{"T":"WFC%20","S":-1,"TS":[0,23,0,0]}]},{"x":82.663,"y":3.7779999999999996,"w":2.224,"clr":0,"A":"left","R":[{"T":"2013","S":-1,"TS":[0,39,0,0]}]},{"x":28.462,"y":2.678,"w":19.698,"clr":0,"A":"left","R":[{"T":"Oregon%20Working%20Family%20Child%20Care%20Credit","S":-1,"TS":[0,17.5,0,0]}]},{"x":39.35,"y":3.928,"w":10.96,"clr":0,"A":"left","R":[{"T":"for%20Full-Year%20Residents","S":-1,"TS":[0,17.5,0,0]}]},{"x":85.385,"y":32.866,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":6.086,"y":32.344,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"%20%209.","S":-1,"TS":[0,11,0,0]}]},{"x":83.696,"y":32.969,"w":0.556,"clr":0,"A":"left","R":[{"T":"9","S":-1,"TS":[0,11,0,0]}]},{"x":85.389,"y":36.555,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":85.389,"y":37.306,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":85.389,"y":38.058,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":85.389,"y":38.809,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":5.938,"y":35.869,"w":12.762,"clr":0,"A":"left","R":[{"T":"First%20and%20Last%20Name%20of%20Child","S":-1,"TS":[0,11,0,0]}]},{"x":45.652,"y":35.869,"w":5.388999999999999,"clr":0,"A":"left","R":[{"T":"Child%E2%80%99s%20SSN","S":-1,"TS":[0,11,0,0]}]},{"x":60.189,"y":35.27,"w":3.093,"clr":0,"A":"left","R":[{"T":"Child%E2%80%99s","S":-1,"TS":[0,11,0,0]}]},{"x":58.394,"y":35.869,"w":5.630000000000002,"clr":0,"A":"left","R":[{"T":"Date%20of%20Birth","S":-1,"TS":[0,11,0,0]}]},{"x":73.237,"y":35.842,"w":5.797000000000001,"clr":0,"A":"left","R":[{"T":"Relationship%20","S":-1,"TS":[0,10.2,0,0]}]},{"x":5.937,"y":36.531,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"10.","S":-1,"TS":[0,11.5,0,0]}]},{"x":6.061,"y":37.283,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"11.","S":-1,"TS":[0,11.5,0,0]}]},{"x":5.937,"y":38.034,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"12.","S":-1,"TS":[0,11.5,0,0]}]},{"x":5.937,"y":38.789,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"13.","S":-1,"TS":[0,11.5,0,0]}]},{"x":85.715,"y":35.27,"w":9.353000000000002,"clr":0,"A":"left","R":[{"T":"Qualifying%20Expenses%20","S":-1,"TS":[0,11,0,0]}]},{"x":86.441,"y":35.869,"w":8.129999999999999,"clr":0,"A":"left","R":[{"T":"You%20Paid%20for%20Child","S":-1,"TS":[0,11,0,0]}]},{"x":6.298,"y":4.975,"w":4.669,"clr":0,"A":"left","R":[{"T":"Last%20name","S":2,"TS":[0,10,0,0]}]},{"x":6.298,"y":6.461,"w":17.818,"clr":0,"A":"left","R":[{"T":"Spouse%E2%80%99s%2FRDP%E2%80%99s%20last%20name%20if%20joint%20return","S":2,"TS":[0,10,0,0]}]},{"x":37.15,"y":4.975,"w":9.243000000000002,"clr":0,"A":"left","R":[{"T":"First%20name%20and%20initial","S":2,"TS":[0,10,0,0]}]},{"x":37.15,"y":6.438,"w":21.388,"clr":0,"A":"left","R":[{"T":"Spouse%E2%80%99s%2FRDP%E2%80%99s%20first%20name%20and%20initial%20if%20joint%20return","S":-1,"TS":[0,9.5,0,0]}]},{"x":61.797,"y":4.975,"w":13.186000000000002,"clr":0,"A":"left","R":[{"T":"Social%20Security%20number%20(SSN)","S":2,"TS":[0,10,0,0]}]},{"x":61.797,"y":6.461,"w":15.161,"clr":0,"A":"left","R":[{"T":"Spouse%E2%80%99s%2FRDP%E2%80%99s%20SSN%20if%20joint%20return","S":2,"TS":[0,10,0,0]}]},{"x":83.694,"y":5.052,"w":7.5569999999999995,"clr":0,"A":"left","R":[{"T":"Attending%20school","S":2,"TS":[0,10,0,0]}]},{"x":83.694,"y":6.54,"w":7.5569999999999995,"clr":0,"A":"left","R":[{"T":"Attending%20school","S":2,"TS":[0,10,0,0]}]},{"x":83.694,"y":5.771,"w":11.669000000000002,"clr":0,"A":"left","R":[{"T":"Form%20WFC-DP%20is%20included","S":2,"TS":[0,10,0,0]}]},{"x":83.694,"y":7.257999999999999,"w":11.669000000000002,"clr":0,"A":"left","R":[{"T":"Form%20WFC-DP%20is%20included","S":2,"TS":[0,10,0,0]}]},{"x":5.968,"y":21.58,"w":19.412000000000003,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20full%20name%20and%20complete%20address%20","S":-1,"TS":[0,10.84,0,0]}]},{"x":85.33,"y":23.086,"w":13.021,"clr":0,"A":"left","R":[{"T":"Amount%20You%20Paid%20to%20Provider","S":51,"TS":[0,9,0,0]}]},{"x":85.435,"y":23.819,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":87.668,"y":21.11,"w":7.7780000000000005,"clr":0,"A":"left","R":[{"T":"Child%20to%20Provider%20","S":-1,"TS":[0,9.5,0,0]}]},{"x":63.012,"y":21.62,"w":7.9990000000000006,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20SSN%20or","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":6.647,"y":22.407,"w":0.8340000000000001,"clr":0,"A":"left","R":[{"T":"6.","S":-1,"TS":[0,11,0,0]}]},{"x":8,"y":22.407,"w":2.649,"clr":0,"A":"left","R":[{"T":"Name","S":-1,"TS":[0,9.5,0,0]}]},{"x":10.965,"y":22.407,"w":45,"clr":0,"A":"left","R":[{"T":"__________________________________________________________________________________________","S":-1,"TS":[0,9.5,0,0]}]},{"x":8,"y":23.157,"w":2.1670000000000003,"clr":0,"A":"left","R":[{"T":"Addr","S":-1,"TS":[0,9.5,0,0]}]},{"x":10.401,"y":23.157,"w":1.537,"clr":0,"A":"left","R":[{"T":"ess","S":-1,"TS":[0,9.5,0,0]}]},{"x":12.641,"y":23.157,"w":43.5,"clr":0,"A":"left","R":[{"T":"_______________________________________________________________________________________","S":-1,"TS":[0,9.5,0,0]}]},{"x":8,"y":23.844,"w":9.445,"clr":0,"A":"left","R":[{"T":"City%2C%20State%2C%20ZIP%20Code","S":-1,"TS":[0,9.5,0,0]}]},{"x":63.012,"y":23.1,"w":11.334000000000001,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20Telephone%20No.","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":77.978,"y":23.842,"w":4.726,"clr":0,"A":"left","R":[{"T":"..............%206","S":-1,"TS":[0,11,0,0]}]},{"x":85.389,"y":40.187,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":5.937,"y":39.535,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"14.","S":-1,"TS":[0,11.5,0,0]}]},{"x":71.375,"y":40.199,"w":4.726000000000001,"clr":0,"A":"left","R":[{"T":".................","S":-1,"TS":[0,16.8793,0,0]}]},{"x":82.784,"y":40.245,"w":1.112,"clr":0,"A":"left","R":[{"T":"14","S":-1,"TS":[0,11,0,0]}]},{"x":5.937,"y":41.026,"w":10.626999999999999,"clr":0,"A":"left","R":[{"T":"Computation%20of%20Credit","S":3,"TS":[0,12,0,0]}]},{"x":5.937,"y":41.776,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"15.","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.412,"y":41.776,"w":25.820000000000007,"clr":0,"A":"left","R":[{"T":"Enter%20your%20federal%20adjusted%20gross%20income%20(Form%2040%2C%20line%208)","S":-1,"TS":[0,11.5,0,0]}]},{"x":46.145,"y":41.776,"w":26.68799999999997,"clr":0,"A":"left","R":[{"T":"................................................................................................","S":-1,"TS":[0,11.5,0,0]}]},{"x":85.437,"y":41.776,"w":1.112,"clr":0,"A":"left","R":[{"T":"15","S":-1,"TS":[0,11.5,0,0]}]},{"x":5.937,"y":42.526,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"16.","S":-1,"TS":[0,11.5,0,0]}]},{"x":60.766,"y":42.526,"w":16.680000000000017,"clr":0,"A":"left","R":[{"T":"............................................................","S":-1,"TS":[0,11.5,0,0]}]},{"x":85.437,"y":42.526,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"16%20","S":-1,"TS":[0,11.5,0,0]}]},{"x":5.937,"y":43.276,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"17.","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.412,"y":44.026,"w":44.52999999999995,"clr":0,"A":"left","R":[{"T":"matches%20your%20household%20size%20on%20line%205%20above).%20For%20example%2C%20if%20the%20amount%20on%20line%205%20is%204%2C%20use%20Table%204","S":-1,"TS":[0,11.5,0,0]}]},{"x":73.357,"y":44.026,"w":7.784000000000006,"clr":0,"A":"left","R":[{"T":"............................","S":-1,"TS":[0,11.5,0,0]}]},{"x":85.437,"y":44.026,"w":1.112,"clr":0,"A":"left","R":[{"T":"17","S":-1,"TS":[0,11.5,0,0]}]},{"x":5.936,"y":44.776,"w":1.3900000000000001,"clr":0,"A":"left","R":[{"T":"18.","S":-1,"TS":[0,11.5,0,0]}]},{"x":37.209,"y":45.526,"w":32.803999999999945,"clr":0,"A":"left","R":[{"T":"......................................................................................................................","S":-1,"TS":[0,11.5,0,0]}]},{"x":85.436,"y":45.526,"w":1.112,"clr":0,"A":"left","R":[{"T":"18","S":-1,"TS":[0,11.5,0,0]}]},{"x":88.252,"y":43.935,"w":0.796,"clr":0,"A":"left","R":[{"T":"x%20","S":-1,"TS":[0,13,0,0]}]},{"x":5.968,"y":25.371,"w":19.412000000000003,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20full%20name%20and%20complete%20address%20","S":-1,"TS":[0,10.84,0,0]}]},{"x":85.33,"y":26.877,"w":13.021,"clr":0,"A":"left","R":[{"T":"Amount%20You%20Paid%20to%20Provider","S":51,"TS":[0,9,0,0]}]},{"x":85.435,"y":27.611,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":6.647,"y":26.198,"w":0.8340000000000001,"clr":0,"A":"left","R":[{"T":"7.","S":-1,"TS":[0,11,0,0]}]},{"x":8,"y":26.198,"w":2.649,"clr":0,"A":"left","R":[{"T":"Name","S":-1,"TS":[0,9.5,0,0]}]},{"x":10.965,"y":26.198,"w":45,"clr":0,"A":"left","R":[{"T":"__________________________________________________________________________________________","S":-1,"TS":[0,9.5,0,0]}]},{"x":8,"y":26.948,"w":2.1670000000000003,"clr":0,"A":"left","R":[{"T":"Addr","S":-1,"TS":[0,9.5,0,0]}]},{"x":10.401,"y":26.948,"w":1.537,"clr":0,"A":"left","R":[{"T":"ess","S":-1,"TS":[0,9.5,0,0]}]},{"x":12.641,"y":26.948,"w":43.5,"clr":0,"A":"left","R":[{"T":"_______________________________________________________________________________________","S":-1,"TS":[0,9.5,0,0]}]},{"x":8,"y":27.636,"w":9.445,"clr":0,"A":"left","R":[{"T":"City%2C%20State%2C%20ZIP%20Code","S":-1,"TS":[0,9.5,0,0]}]},{"x":63.012,"y":26.891,"w":11.334000000000001,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20Telephone%20No.","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":77.978,"y":27.633,"w":4.726,"clr":0,"A":"left","R":[{"T":"..............%207","S":-1,"TS":[0,11,0,0]}]},{"x":5.938,"y":8.889,"w":1.352,"clr":0,"A":"left","R":[{"T":"PA","S":3,"TS":[0,12,0,0]}]},{"x":7.800000000000001,"y":8.889,"w":20.467000000000002,"clr":0,"A":"left","R":[{"T":"YMENT%20OF%20YOUR%20CHILD%20CARE%20EXPENSES","S":3,"TS":[0,12,0,0]}]},{"x":87.668,"y":24.895,"w":7.7780000000000005,"clr":0,"A":"left","R":[{"T":"Child%20to%20Provider%20","S":-1,"TS":[0,9.5,0,0]}]},{"x":5.968,"y":29.121,"w":19.412000000000003,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20full%20name%20and%20complete%20address%20","S":-1,"TS":[0,10.84,0,0]}]},{"x":85.33,"y":30.627,"w":13.021,"clr":0,"A":"left","R":[{"T":"Amount%20You%20Paid%20to%20Provider","S":51,"TS":[0,9,0,0]}]},{"x":85.435,"y":31.360999999999997,"w":0.556,"clr":0,"A":"left","R":[{"T":"%24","S":3,"TS":[0,12,0,0]}]},{"x":6.647,"y":29.948,"w":0.8340000000000001,"clr":0,"A":"left","R":[{"T":"8.","S":-1,"TS":[0,11,0,0]}]},{"x":8,"y":29.948,"w":2.649,"clr":0,"A":"left","R":[{"T":"Name","S":-1,"TS":[0,9.5,0,0]}]},{"x":10.965,"y":29.948,"w":45,"clr":0,"A":"left","R":[{"T":"__________________________________________________________________________________________","S":-1,"TS":[0,9.5,0,0]}]},{"x":8,"y":30.698,"w":2.1670000000000003,"clr":0,"A":"left","R":[{"T":"Addr","S":-1,"TS":[0,9.5,0,0]}]},{"x":10.401,"y":30.698,"w":1.537,"clr":0,"A":"left","R":[{"T":"ess","S":-1,"TS":[0,9.5,0,0]}]},{"x":12.641,"y":30.698,"w":43.5,"clr":0,"A":"left","R":[{"T":"_______________________________________________________________________________________","S":-1,"TS":[0,9.5,0,0]}]},{"x":8,"y":31.386000000000003,"w":9.445,"clr":0,"A":"left","R":[{"T":"City%2C%20State%2C%20ZIP%20Code","S":-1,"TS":[0,9.5,0,0]}]},{"x":63.012,"y":30.641,"w":11.334000000000001,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20Telephone%20No.","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":77.978,"y":31.383000000000003,"w":4.726,"clr":0,"A":"left","R":[{"T":"..............%208","S":-1,"TS":[0,11,0,0]}]},{"x":87.668,"y":28.645,"w":7.7780000000000005,"clr":0,"A":"left","R":[{"T":"Child%20to%20Provider%20","S":-1,"TS":[0,9.5,0,0]}]},{"x":5.938,"y":47.393,"w":11.469000000000005,"clr":0,"A":"left","R":[{"T":"150-101-169%20(Rev.%2012-13)","S":51,"TS":[0,9,0,0]}]},{"x":61.872,"y":5.781,"w":5.005,"clr":0,"A":"left","R":[{"T":"%20%20%20-%20%20-","S":-1,"TS":[0,13,0,0]}]},{"x":61.872,"y":7.281000000000001,"w":5.005,"clr":0,"A":"left","R":[{"T":"%20%20%20-%20%20-","S":-1,"TS":[0,13,0,0]}]},{"x":57.347,"y":13.666,"w":13.559,"clr":0,"A":"left","R":[{"T":"FOR%20COMPUTER%20USE%20ONLY","S":5,"TS":[0,18,0,0]}]},{"x":5.938,"y":8.214,"w":27.28099999999999,"clr":0,"A":"left","R":[{"T":"YOU%20MAY%20BE%20REQUIRED%20TO%20PROvIDE%20PROOF%20OF%20YOUR%20","S":3,"TS":[0,12,0,0]}]},{"x":8.448,"y":12.702,"w":22.596,"clr":0,"A":"left","R":[{"T":"claim%20on%20your%20federal%20return%20because%20you%20released%20","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.448,"y":13.452,"w":18.172000000000004,"clr":0,"A":"left","R":[{"T":"the%20exemption%20to%20the%20child%E2%80%99s%20other%20parent","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.451,"y":15.702000000000002,"w":21.40900000000001,"clr":0,"A":"left","R":[{"T":"federal%20return%20for%20people%20who%20did%20not%20live%20in%20your","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.451,"y":17.203,"w":22.374,"clr":0,"A":"left","R":[{"T":"to%20you%20by%20your%20child%E2%80%99s%20other%20parent%2C%20or%20who%20are%20not","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.451,"y":17.953,"w":20.05900000000001,"clr":0,"A":"left","R":[{"T":"related%20by%20blood%2C%20marriage%2C%20RDP%2C%20or%20adoption","S":-1,"TS":[0,11.5,0,0]}]},{"x":5.938,"y":20.114,"w":54.412999999999954,"clr":0,"A":"left","R":[{"T":"Qualifying%20Child%20Care%20Expenses%20Paid%20in%202013.%20Complete%20all%20information%20for%20each%20child%20care%20provider%20you%20paid%20in%202013.","S":3,"TS":[0,12,0,0]}]},{"x":8.412,"y":42.526,"w":35.711999999999996,"clr":0,"A":"left","R":[{"T":"Enter%20the%20total%20qualifying%20child%20care%20expenses%20you%20paid%20in%202013%20from%20line%209%20above","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.412,"y":43.276,"w":46.28999999999996,"clr":0,"A":"left","R":[{"T":"Enter%20the%20decimal%20amount%20from%20the%20working%20family%20child%20care%20credit%20table%20on%20the%20back%20(use%20the%20table%20that%20","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.411,"y":44.776,"w":49.29799999999995,"clr":0,"A":"left","R":[{"T":"Multiply%20the%20amount%20on%20line%2016%20by%20the%20decimal%20amount%20on%20line%2017.%20Enter%20the%20result%20here%20and%20on%20Form%2040%2C%20line%2045.","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.411,"y":45.526,"w":19.538,"clr":0,"A":"left","R":[{"T":"This%20is%20your%20working%20family%20child%20care%20credit%20","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.561,"y":32.344,"w":26.601999999999997,"clr":0,"A":"left","R":[{"T":"Add%20amounts%20on%20lines%206%20through%208%20and%20enter%20the%20result%20here.","S":-1,"TS":[0,11,0,0]}]},{"x":8.436,"y":32.969,"w":33.209,"clr":0,"A":"left","R":[{"T":"If%20you%20have%20more%20than%20three%20providers%2C%20enter%20additional%20qualifying%20providers","S":-1,"TS":[0,11,0,0]}]},{"x":56.62,"y":32.969,"w":9.096000000000004,"clr":0,"A":"left","R":[{"T":"and%20check%20here%20%20%209a%20","S":-1,"TS":[0,11,0,0]}]},{"x":8.412,"y":39.535,"w":23.069999999999993,"clr":0,"A":"left","R":[{"T":"Add%20amounts%20on%20lines%2010%20through%2013%20and%20enter%20the%20result%20here.","S":-1,"TS":[0,11.5,0,0]}]},{"x":8.266,"y":40.201,"w":29.98,"clr":0,"A":"left","R":[{"T":"If%20you%20have%20more%20than%20four%20qualifying%20children%2C%20enter%20additional%20qualifying%20children","S":-1,"TS":[0,11.5,0,0]}]},{"x":59.375,"y":40.201,"w":7.824000000000001,"clr":0,"A":"left","R":[{"T":"and%20check%20here%20%20%2014a","S":-1,"TS":[0,11.5,0,0]}]},{"x":72.194,"y":32.992,"w":4.726000000000001,"clr":0,"A":"left","R":[{"T":".................","S":-1,"TS":[0,16.8793,0,0]}]},{"x":75.473,"y":21.62,"w":6.9620000000000015,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20FEIN","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":63.012,"y":25.433,"w":7.9990000000000006,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20SSN%20or","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":75.473,"y":25.433,"w":6.9620000000000015,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20FEIN","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":63.012,"y":29.151,"w":7.9990000000000006,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20SSN%20or","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":75.473,"y":29.151,"w":6.9620000000000015,"clr":0,"A":"left","R":[{"T":"Provider%E2%80%99s%20FEIN","S":-1,"TS":[0,9.629999999999999,0,0]}]},{"x":87.668,"y":21.548,"w":5.519,"clr":0,"A":"left","R":[{"T":"Relationship","S":-1,"TS":[0,9.5,0,0]}]},{"x":87.668,"y":25.36,"w":5.519,"clr":0,"A":"left","R":[{"T":"Relationship","S":-1,"TS":[0,9.5,0,0]}]},{"x":87.668,"y":29.048,"w":5.519,"clr":0,"A":"left","R":[{"T":"Relationship","S":-1,"TS":[0,9.5,0,0]}]},{"x":5.938,"y":34.5,"w":25.872,"clr":0,"A":"left","R":[{"T":"Qualifying%20Child%20Information--Complete%20all%20information","S":-1,"TS":[0,11,0,0]}]},{"x":25.222,"y":35,"w":6.498,"clr":0,"A":"left","R":[{"T":"for%20each%20child","S":-1,"TS":[0,11,0,0]}]},{"x":71.747,"y":35.342,"w":8.167,"clr":0,"A":"left","R":[{"T":"Child%20to%20Taxpayer%20","S":-1,"TS":[0,10.2,0,0]}]}],"Fields":[{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"TPNAME","EN":0},"TI":574,"AM":1024,"x":6.716,"y":5.924,"w":29.998,"h":0.833},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"TPFNAM","EN":0},"TI":575,"AM":1024,"x":37.388,"y":5.897,"w":18.978,"h":0.833},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"TPINIT","EN":0},"TI":576,"AM":1024,"x":56.885,"y":5.901,"w":4.595,"h":0.833,"TU":"Taxpayer middle initial"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"TPSSN","EN":0},"TI":577,"AM":1024,"x":62.067,"y":5.934,"w":17.814,"h":0.833,"TU":"Your social security number. 9 digits."},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"SPNAME","EN":0},"TI":579,"AM":1024,"x":6.598,"y":7.398,"w":30.063,"h":0.833,"TU":"Spouse’s/RDP’s last name if joint return"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"SPFNAM","EN":0},"TI":581,"AM":1024,"x":37.528,"y":7.43,"w":18.859,"h":0.833,"TU":"Spouse’s/RDP’s first name and initial if joint return"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"SPINIT","EN":0},"TI":582,"AM":1024,"x":56.641,"y":7.445,"w":4.894,"h":0.833,"TU":"Spouse middle initial"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"SPSSN","EN":0},"TI":583,"AM":1024,"x":62.122,"y":7.424,"w":17.889,"h":0.833,"TU":"spouse social security number. 9 digits."},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"EXCLM","EN":0},"TI":585,"AM":0,"x":44.736,"y":11.258,"w":4.599,"h":0.833},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"EXNOCLM","EN":0},"TI":586,"AM":0,"x":44.792,"y":13.522,"w":4.599,"h":0.833},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"EXTOT","EN":0},"TI":587,"AM":1024,"x":44.847,"y":14.25,"w":4.599,"h":0.833},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"EXNR","EN":0},"TI":588,"AM":0,"x":44.752,"y":18.027,"w":4.599,"h":0.833},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"TOTHHSZ","EN":0},"TI":589,"AM":1024,"x":44.806,"y":18.809,"w":4.599,"h":0.833},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVNM_1_","EN":0},"TI":590,"AM":0,"x":11.22,"y":22.545,"w":50.263,"h":0.833,"TU":"6. Name"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"PROV_TEMPSSN_1_","EN":0},"TI":591,"AM":0,"x":62.289,"y":22.505,"w":12.506,"h":0.833,"TU":"SSN"},{"style":48,"T":{"Name":"mask","TypeInfo":{}},"id":{"Id":"PROV_PROVEIN_1_","EN":0},"TI":592,"AM":0,"x":75.322,"y":22.52,"w":12.506,"h":0.833,"TU":"FEIN","MV":"99-9999999"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVREL_1_","EN":0},"TI":593,"AM":0,"x":88.136,"y":22.476,"w":16.068,"h":0.833,"PL":{"V":[null,"Son","Daughter","Stepson","Stepdaughter","Grandchild","Niece","Nephew ","Sister/Brother","Eligible foster child","Aunt","Uncle","Cousin","Sister-in-law","Brother-in-law","Other relative","None"],"D":[" ","S","D","SS","SD","GC","NC","NW","SB","EF","A","U","CS","SL","BL","O","N"]}},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVADDR_1_","EN":0},"TI":594,"AM":0,"x":12.891,"y":23.295,"w":48.593,"h":0.833,"TU":"address"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVCTY_1_","EN":0},"TI":595,"AM":0,"x":18.977,"y":24.057,"w":28.079,"h":0.833,"TU":"CITY"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVST_1_","EN":0},"TI":596,"AM":0,"x":47.331,"y":24.026,"w":4.891,"h":0.833,"PL":{"V":[" ","AL","AK","AS","AZ","AR","CA","CO","MP","CT","DE","DC","FM","FL","GA","GU","HI","ID","IL","IN","IA","KS","KY","LA","ME","MH","MD","MA","MI","MN","MS","MO","MT","NE","NV","NH","NJ","NM","NY","NC","ND","OH","OK","OR","PW","PA","PR","RI","SC","SD","TN","TX","UT","VT","VI","VA","WA","WV","WI","WY","AA","AE","AP"],"D":["no entry","AL","AK","AS","AZ","AR","CA","CO","MP","CT","DE","DC","FM","FL","GA","GU","HI","ID","IL","IN","IA","KS","KY","LA","ME","MH","MD","MA","MI","MN","MS","MO","MT","NE","NV","NH","NJ","NM","NY","NC","ND","OH","OK","OR","PW","PA","PR","RI","SC","SD","TN","TX","UT","VT","VI","VA","WA","WV","WI","WY","AA","AE","AP"]}},{"style":48,"T":{"Name":"zip","TypeInfo":{}},"id":{"Id":"PROV_PROVZIP_1_","EN":0},"TI":597,"AM":0,"x":53.179,"y":24.087,"w":8.263,"h":0.833,"TU":"ZIP"},{"style":48,"T":{"Name":"phone","TypeInfo":{}},"id":{"Id":"PROV_PROVPHN_1_","EN":0},"TI":598,"AM":0,"x":63.373,"y":24.031,"w":14.378,"h":0.833,"TU":"PHONE"},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"PROV_PROVAMT_1_","EN":0},"TI":599,"AM":0,"x":86.419,"y":24.03,"w":12.519,"h":0.833,"TU":"Amount You Paid to Provider"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVNM_2_","EN":0},"TI":600,"AM":0,"x":11.318,"y":26.356,"w":50.263,"h":0.833,"TU":"6. Name"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"PROV_TEMPSSN_2_","EN":0},"TI":601,"AM":0,"x":62.248,"y":26.351,"w":12.506,"h":0.833,"TU":"SSN"},{"style":48,"T":{"Name":"mask","TypeInfo":{}},"id":{"Id":"PROV_PROVEIN_2_","EN":0},"TI":602,"AM":0,"x":75.28,"y":26.366,"w":12.506,"h":0.833,"TU":"FEIN","MV":"99-9999999"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVREL_2_","EN":0},"TI":603,"AM":0,"x":87.996,"y":26.327,"w":16.068,"h":0.833,"PL":{"V":[null,"Son","Daughter","Stepson","Stepdaughter","Grandchild","Niece","Nephew ","Sister/Brother","Eligible foster child","Aunt","Uncle","Cousin","Sister-in-law","Brother-in-law","Other relative","None"],"D":[" ","S","D","SS","SD","GC","NC","NW","SB","EF","A","U","CS","SL","BL","O","N"]}},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVADDR_2_","EN":0},"TI":604,"AM":0,"x":12.989,"y":27.106,"w":48.593,"h":0.833,"TU":"address"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVCTY_2_","EN":0},"TI":605,"AM":0,"x":18.977,"y":27.828,"w":28.079,"h":0.833,"TU":"CITY"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVST_2_","EN":0},"TI":606,"AM":0,"x":47.541,"y":27.837,"w":4.891,"h":0.833,"PL":{"V":[" ","AL","AK","AS","AZ","AR","CA","CO","MP","CT","DE","DC","FM","FL","GA","GU","HI","ID","IL","IN","IA","KS","KY","LA","ME","MH","MD","MA","MI","MN","MS","MO","MT","NE","NV","NH","NJ","NM","NY","NC","ND","OH","OK","OR","PW","PA","PR","RI","SC","SD","TN","TX","UT","VT","VI","VA","WA","WV","WI","WY","AA","AE","AP"],"D":["no entry","AL","AK","AS","AZ","AR","CA","CO","MP","CT","DE","DC","FM","FL","GA","GU","HI","ID","IL","IN","IA","KS","KY","LA","ME","MH","MD","MA","MI","MN","MS","MO","MT","NE","NV","NH","NJ","NM","NY","NC","ND","OH","OK","OR","PW","PA","PR","RI","SC","SD","TN","TX","UT","VT","VI","VA","WA","WV","WI","WY","AA","AE","AP"]}},{"style":48,"T":{"Name":"zip","TypeInfo":{}},"id":{"Id":"PROV_PROVZIP_2_","EN":0},"TI":607,"AM":0,"x":53.277,"y":27.898,"w":8.263,"h":0.833,"TU":"ZIP"},{"style":48,"T":{"Name":"phone","TypeInfo":{}},"id":{"Id":"PROV_PROVPHN_2_","EN":0},"TI":608,"AM":0,"x":63.472,"y":27.842,"w":14.378,"h":0.833,"TU":"PHONE"},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"PROV_PROVAMT_2_","EN":0},"TI":609,"AM":0,"x":86.517,"y":27.841,"w":12.519,"h":0.833,"TU":"Amount You Paid to Provider"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVNM_3_","EN":0},"TI":610,"AM":0,"x":11.243,"y":30.053,"w":50.263,"h":0.833,"TU":"6. Name"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"PROV_TEMPSSN_3_","EN":0},"TI":611,"AM":0,"x":62.153,"y":30.019,"w":12.506,"h":0.833,"TU":"SSN"},{"style":48,"T":{"Name":"mask","TypeInfo":{}},"id":{"Id":"PROV_PROVEIN_3_","EN":0},"TI":612,"AM":0,"x":75.185,"y":30.034,"w":12.506,"h":0.833,"TU":"FEIN","MV":"99-9999999"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVREL_3_","EN":0},"TI":613,"AM":0,"x":87.975,"y":29.968,"w":16.068,"h":0.833,"PL":{"V":[null,"Son","Daughter","Stepson","Stepdaughter","Grandchild","Niece","Nephew ","Sister/Brother","Eligible foster child","Aunt","Uncle","Cousin","Sister-in-law","Brother-in-law","Other relative","None"],"D":[" ","S","D","SS","SD","GC","NC","NW","SB","EF","A","U","CS","SL","BL","O","N"]}},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVADDR_3_","EN":0},"TI":614,"AM":0,"x":12.914,"y":30.803,"w":48.592,"h":0.833,"TU":"address"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVCTY_3_","EN":0},"TI":615,"AM":0,"x":19.182,"y":31.577,"w":28.079,"h":0.833,"TU":"CITY"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"PROV_PROVST_3_","EN":0},"TI":616,"AM":0,"x":47.67,"y":31.587,"w":4.891,"h":0.833,"PL":{"V":[" ","AL","AK","AS","AZ","AR","CA","CO","MP","CT","DE","DC","FM","FL","GA","GU","HI","ID","IL","IN","IA","KS","KY","LA","ME","MH","MD","MA","MI","MN","MS","MO","MT","NE","NV","NH","NJ","NM","NY","NC","ND","OH","OK","OR","PW","PA","PR","RI","SC","SD","TN","TX","UT","VT","VI","VA","WA","WV","WI","WY","AA","AE","AP"],"D":["no entry","AL","AK","AS","AZ","AR","CA","CO","MP","CT","DE","DC","FM","FL","GA","GU","HI","ID","IL","IN","IA","KS","KY","LA","ME","MH","MD","MA","MI","MN","MS","MO","MT","NE","NV","NH","NJ","NM","NY","NC","ND","OH","OK","OR","PW","PA","PR","RI","SC","SD","TN","TX","UT","VT","VI","VA","WA","WV","WI","WY","AA","AE","AP"]}},{"style":48,"T":{"Name":"zip","TypeInfo":{}},"id":{"Id":"PROV_PROVZIP_3_","EN":0},"TI":617,"AM":0,"x":53.203,"y":31.594,"w":8.263,"h":0.833,"TU":"ZIP"},{"style":48,"T":{"Name":"phone","TypeInfo":{}},"id":{"Id":"PROV_PROVPHN_3_","EN":0},"TI":618,"AM":0,"x":63.397,"y":31.538,"w":14.378,"h":0.833,"TU":"PHONE"},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"PROV_PROVAMT_3_","EN":0},"TI":619,"AM":0,"x":86.442,"y":31.538,"w":12.519,"h":0.833,"TU":"Amount You Paid to Provider"},{"style":48,"T":{"Name":"link"},"FL":{"form":{"Id":"ORWFCDEP"}},"id":{"Id":"ADD_WFCDEP_P","EN":0},"TI":620,"AM":0,"x":52.101,"y":33.172,"w":2.343,"h":0.833},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"TOTCREXP","EN":0},"TI":622,"AM":1024,"x":86.378,"y":33.075,"w":12.561,"h":0.833},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"QCHILD_NCPNAME_1_","EN":0},"TI":623,"AM":0,"x":8.559,"y":36.771,"w":33.792,"h":0.833,"TU":"Child's Name"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"QCHILD_NCPSSN_1_","EN":0},"TI":624,"AM":0,"x":42.859,"y":36.742,"w":13.406,"h":0.833,"TU":"Child’s SSN"},{"style":48,"T":{"Name":"date","TypeInfo":{}},"id":{"Id":"QCHILD_NCPDOB_1_","EN":0},"TI":625,"AM":0,"x":56.492,"y":36.742,"w":12.086,"h":0.833,"TU":"Child’s Date of Birth","MV":"mm/dd/yyyy"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"QCHILD_NCPREL_1_","EN":0},"TI":626,"AM":0,"x":68.829,"y":36.754,"w":16.068,"h":0.833,"PL":{"V":[null,"Son","Daughter","Stepson","Stepdaughter","Grandchild","Niece","Nephew ","Sister/Brother","Eligible foster child","Aunt","Uncle","Cousin","Sister-in-law","Brother-in-law","Other relative","None"],"D":[" ","S","D","SS","SD","GC","NC","NW","SB","EF","A","U","CS","SL","BL","O","N"]}},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"QCHILD_CHILDEXP_1_","EN":0},"TI":627,"AM":0,"x":86.398,"y":36.742,"w":12.561,"h":0.833,"TU":"You Paid for Child"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"QCHILD_NCPNAME_2_","EN":0},"TI":628,"AM":0,"x":8.555,"y":37.508,"w":33.792,"h":0.833,"TU":"Child's Name"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"QCHILD_NCPSSN_2_","EN":0},"TI":629,"AM":0,"x":42.855,"y":37.48,"w":13.406,"h":0.833,"TU":"Child’s SSN"},{"style":48,"T":{"Name":"date","TypeInfo":{}},"id":{"Id":"QCHILD_NCPDOB_2_","EN":0},"TI":630,"AM":0,"x":56.488,"y":37.48,"w":12.086,"h":0.833,"TU":"Child’s Date of Birth","MV":"mm/dd/yyyy"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"QCHILD_NCPREL_2_","EN":0},"TI":631,"AM":0,"x":68.755,"y":37.517,"w":16.068,"h":0.833,"PL":{"V":[null,"Son","Daughter","Stepson","Stepdaughter","Grandchild","Niece","Nephew ","Sister/Brother","Eligible foster child","Aunt","Uncle","Cousin","Sister-in-law","Brother-in-law","Other relative","None"],"D":[" ","S","D","SS","SD","GC","NC","NW","SB","EF","A","U","CS","SL","BL","O","N"]}},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"QCHILD_CHILDEXP_2_","EN":0},"TI":632,"AM":0,"x":86.394,"y":37.48,"w":12.561,"h":0.833,"TU":"You Paid for Child"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"QCHILD_NCPNAME_3_","EN":0},"TI":633,"AM":0,"x":8.54,"y":38.291,"w":33.792,"h":0.833,"TU":"Child's Name"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"QCHILD_NCPSSN_3_","EN":0},"TI":634,"AM":0,"x":42.84,"y":38.263,"w":13.406,"h":0.833,"TU":"Child’s SSN"},{"style":48,"T":{"Name":"date","TypeInfo":{}},"id":{"Id":"QCHILD_NCPDOB_3_","EN":0},"TI":635,"AM":0,"x":56.473,"y":38.263,"w":12.086,"h":0.833,"TU":"Child’s Date of Birth","MV":"mm/dd/yyyy"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"QCHILD_NCPREL_3_","EN":0},"TI":636,"AM":0,"x":68.68,"y":38.224,"w":16.068,"h":0.833,"PL":{"V":[null,"Son","Daughter","Stepson","Stepdaughter","Grandchild","Niece","Nephew ","Sister/Brother","Eligible foster child","Aunt","Uncle","Cousin","Sister-in-law","Brother-in-law","Other relative","None"],"D":[" ","S","D","SS","SD","GC","NC","NW","SB","EF","A","U","CS","SL","BL","O","N"]}},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"QCHILD_CHILDEXP_3_","EN":0},"TI":637,"AM":0,"x":86.379,"y":38.263,"w":12.561,"h":0.833,"TU":"You Paid for Child"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"QCHILD_NCPNAME_4_","EN":0},"TI":638,"AM":0,"x":8.536,"y":39.028,"w":33.792,"h":0.833,"TU":"Child's Name"},{"style":48,"T":{"Name":"ssn","TypeInfo":{}},"id":{"Id":"QCHILD_NCPSSN_4_","EN":0},"TI":639,"AM":0,"x":42.836,"y":39,"w":13.406,"h":0.833,"TU":"Child’s SSN"},{"style":48,"T":{"Name":"date","TypeInfo":{}},"id":{"Id":"QCHILD_NCPDOB_4_","EN":0},"TI":640,"AM":0,"x":56.469,"y":39,"w":12.086,"h":0.833,"TU":"Child’s Date of Birth","MV":"mm/dd/yyyy"},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"QCHILD_NCPREL_4_","EN":0},"TI":641,"AM":0,"x":68.66,"y":39.007,"w":16.068,"h":0.833,"PL":{"V":[null,"Son","Daughter","Stepson","Stepdaughter","Grandchild","Niece","Nephew ","Sister/Brother","Eligible foster child","Aunt","Uncle","Cousin","Sister-in-law","Brother-in-law","Other relative","None"],"D":[" ","S","D","SS","SD","GC","NC","NW","SB","EF","A","U","CS","SL","BL","O","N"]}},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"QCHILD_CHILDEXP_4_","EN":0},"TI":642,"AM":0,"x":86.375,"y":39,"w":12.561,"h":0.833,"TU":"You Paid for Child"},{"style":48,"T":{"Name":"link"},"FL":{"form":{"Id":"ORWFCDEP"}},"id":{"Id":"ADD_WFCDEP_C","EN":0},"TI":643,"AM":0,"x":55.183,"y":40.288,"w":2.343,"h":0.833},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"TOTCCEXP","EN":0},"TI":645,"AM":1024,"x":86.398,"y":40.348,"w":12.561,"h":0.833},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"AGI","EN":0},"TI":646,"AM":1024,"x":88.052,"y":41.8,"w":10.914,"h":0.833},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"QCCEXP","EN":0},"TI":647,"AM":1024,"x":88.052,"y":42.589,"w":10.914,"h":0.833},{"style":48,"T":{"Name":"alpha","TypeInfo":{}},"id":{"Id":"WORKCR","EN":0},"TI":648,"AM":0,"x":89.986,"y":44.084,"w":8.136,"h":0.833,"PL":{"V":[null,"0.40","0.36","0.32","0.24","0.16","0.08","0.00"],"D":[" ","0.40","0.36","0.32","0.24","0.16","0.08","0.00"]}},{"style":48,"T":{"Name":"number","TypeInfo":{}},"id":{"Id":"WFCCCRED","EN":0},"TI":649,"AM":1024,"x":88.069,"y":45.583,"w":10.787,"h":0.833}],"Boxsets":[{"boxes":[{"style":48,"T":{"Name":"box","TypeInfo":{}},"id":{"Id":"SKL1","EN":0},"TI":573,"AM":0,"x":81.366,"y":5.23,"w":1.609,"h":0.833}]},{"boxes":[{"style":48,"T":{"Name":"box","TypeInfo":{}},"id":{"Id":"WFCDP1","EN":0},"TI":578,"AM":0,"x":81.366,"y":5.927,"w":1.609,"h":0.833}]},{"boxes":[{"style":48,"T":{"Name":"box","TypeInfo":{}},"id":{"Id":"SKL2","EN":0},"TI":580,"AM":0,"x":81.366,"y":6.722,"w":1.609,"h":0.833}]},{"boxes":[{"style":48,"T":{"Name":"box","TypeInfo":{}},"id":{"Id":"WFCDP2","EN":0},"TI":584,"AM":0,"x":81.366,"y":7.413,"w":1.609,"h":0.833}]},{"boxes":[{"style":48,"T":{"Name":"box","TypeInfo":{}},"id":{"Id":"TOTBX9","EN":0},"TI":621,"AM":1024,"x":68.242,"y":33.217,"w":1.299,"h":0.833}]},{"boxes":[{"style":48,"T":{"Name":"box","TypeInfo":{}},"id":{"Id":"TOTBX14","EN":0},"TI":644,"AM":1024,"x":71.596,"y":40.404,"w":1.279,"h":0.833}]}]}],"Width":105.188}}