Get the free Dependent Care Advantage Account Reimbursement Request Form - delhi

This form is used by state employees to request reimbursement for dependent care expenses incurred while they or their spouses are working or looking for work.

How to fill out dependent care advantage account

How to fill out Dependent Care Advantage Account Reimbursement Request Form

1. Obtain the Dependent Care Advantage Account Reimbursement Request Form from your employer or the provider's website.
2. Fill out your personal details at the top of the form, including your name, employee ID, and contact information.
3. Complete the dependent information section, including the name and date of birth of each child or dependent in care.
4. Provide details of the care provider, including their name, address, and tax identification number.
5. Indicate the dates of care and the amount you are requesting reimbursement for each date.
6. Attach all required documentation, such as receipts or invoices from the care provider that include the dates of service and amount paid.
7. Review the form to ensure all sections are completed accurately and sign where indicated.
8. Submit the completed form and attachments to the designated department for processing, as outlined by your employer.

Who needs Dependent Care Advantage Account Reimbursement Request Form?

1. Employees who have incurred expenses for child or dependent care services while they work.
2. Parents or guardians who are enrolled in a Dependent Care Advantage Account and wish to receive reimbursement for eligible care expenses.
3. Individuals seeking tax-advantaged methods to manage their dependent care costs.

For pdfFiller’s FAQs

What is Dependent Care Advantage Account Reimbursement Request Form?

The Dependent Care Advantage Account Reimbursement Request Form is a document used by employees to request reimbursement for eligible dependent care expenses incurred while working or looking for work.

Who is required to file Dependent Care Advantage Account Reimbursement Request Form?

Employees who participate in a Dependent Care Advantage Account plan and have eligible dependent care expenses are required to file this form to receive reimbursements.

How to fill out Dependent Care Advantage Account Reimbursement Request Form?

To fill out the form, employees need to provide their personal information, details of the care provider, the type and date of care received, and any receipts or documentation for the expenses incurred.

What is the purpose of Dependent Care Advantage Account Reimbursement Request Form?

The purpose of the form is to enable employees to claim tax-free reimbursements for costs associated with the care of their dependents while they work or seek employment.

What information must be reported on Dependent Care Advantage Account Reimbursement Request Form?

The form must report the employee's name, contact information, dependent's details, provider's name and address, the dates of service, type of care provided, and a description of expenses along with any relevant receipts.