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This document provides instructions on how to file a claim for dependent care expenses, including required documentation and submission methods.

How to fill out dependent care claim submission

How to fill out Dependent Care Claim Submission Form

1. Obtain the Dependent Care Claim Submission Form from your employer's benefits office or website.
2. Fill in your personal information at the top of the form including name, address, and employee ID.
3. Provide details about your dependent(s) such as their names, dates of birth, and relationship to you.
4. Complete the section detailing the care provider, including their name, address, and tax identification number.
5. List the dates of service and the amount paid for each care service provided.
6. Attach any necessary receipts or proof of payment from the care provider.
7. Review the completed form for accuracy.
8. Sign and date the form.
9. Submit the completed form to your employer's HR or benefits department as per their guidelines.

Who needs Dependent Care Claim Submission Form?

1. Parents or guardians who incur costs for the care of their dependent children while they work.
2. Employees seeking reimbursement for eligible dependent care expenses under their employer's benefits plan.
3. Individuals claiming tax credits related to dependent care expenses.

People Also Ask about

How to submit dependent care FSA claim?

Keep Your Receipts Please save your receipts and other supporting documentation related to your DCFSA expenses and claims. The IRS may request itemized receipts to verify the eligibility of your expenses.

How to submit a claim for dependent care in FSA?

Dependent Care FSA Use the FSAFEDS app to have the dependent care provider certify the service by providing a signature on your mobile device. Have the dependent care provider certify the service by signing the completed claim form (PDF). Submit a claim (PDF) with an itemized statement from the dependent care provider.

How is dependent care FSA reported?

To claim the credit, you (and your spouse, if you're married) must have income earned from a job and you must have paid for the care so that you could work or look for work. You can claim from 20% to 35% of your care expenses up to a maximum of $3,000 for one person, or $6,000 for two or more people (tax year 2024).

Is there a tax form for dependent care in FSA?

You're receiving a tax benefit because under the plan, you're not paying taxes on the money set aside to pay for the dependent care expenses. You must complete and attach Form 2441, Child and Dependent Care Expenses to your tax return.

What documentation do I need for dependent care FSA?

Start and end dates of service • Dependent's name and date of birth • Itemization of charges • Provider's name, address, and tax ID or Social Security number • Credit card receipts, canceled checks, and balance forward statements do not meet the requirements for acceptable documentation.

What is the form for dependent care credit?

Form 2441 is used to claim the Child and Dependent Care Credit, which is available to those who pay someone to care for dependent children under 13, disabled spouses, or other dependents who cannot mentally or physically care for themselves.

For pdfFiller’s FAQs

What is Dependent Care Claim Submission Form?

The Dependent Care Claim Submission Form is a document used to claim expenses related to the care of dependents, allowing individuals to receive reimbursement for eligible dependent care costs.

Who is required to file Dependent Care Claim Submission Form?

Employees who incur expenses for the care of dependents while they work or look for work are required to file the Dependent Care Claim Submission Form to seek reimbursement.

How to fill out Dependent Care Claim Submission Form?

To fill out the Dependent Care Claim Submission Form, individuals need to provide their personal information, details of the dependent care provider, the amount spent on care, and any necessary receipts or documentation to support the claim.

What is the purpose of Dependent Care Claim Submission Form?

The purpose of the Dependent Care Claim Submission Form is to facilitate the reimbursement process for individuals claiming expenses incurred for the care of dependents, ensuring that eligible costs are properly documented and submitted.

What information must be reported on Dependent Care Claim Submission Form?

The information that must be reported includes the claimant's name, contact information, details about the dependent care providers (name and address), total amount paid for care, dates of service, and any required documentation or receipts.