ERIECOUNTYGOV
Submitting Your Dependent Child Care FSA Claim How To File a Dependent Child Care FSA Claim To complete a Dependent Care reimbursement request (a claim), you must submit a Dependent Child Care FSA Claim Form along with an itemized receipt or provider certification that clearly shows an eligible service was provided. To complete a reimbursement request, you should: 1. 2. 3. Complete a Dependent Child Care FSA Claim Form Attach itemized receipt(s) or have your Dependent Care Provider certify the expense(s) MoreThe Claim Form must be completed entirely, dated and signed. ... You may submit up to four (4) expenses on a single Dependent Child Care FSA Claim Form, Less
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