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This document provides instructions for filing a dependent care reimbursement claim, including required documentation, eligibility criteria, and submission procedures.

How to fill out dependent care spending account

How to fill out Dependent Care Spending Account Claim Form

1. Obtain the Dependent Care Spending Account Claim Form from your employer or the benefits portal.
2. Fill in your personal information, including your name, employee ID, and contact details at the top of the form.
3. List the dependent(s) for whom you are claiming expenses, including their names and ages.
4. Provide the details of the care provider, including their name, address, and taxpayer identification number (TIN).
5. Enter the dates of service for which you are claiming the expenses.
6. Itemize the expenses incurred for each dependent by listing the amount and type of care provided.
7. Total the expenses at the end of the form, ensuring the total is accurate.
8. Sign and date the form, certifying that the information provided is true and valid.
9. Submit the completed form along with any required receipts or documentation to the appropriate department.

Who needs Dependent Care Spending Account Claim Form?

1. Employees who have eligible dependents and wish to claim reimbursement for child or dependent care expenses.
2. Parents or guardians who incur childcare costs while they work or look for work.
3. Those who are enrolled in a Dependent Care Spending Account as part of their employee benefits package.

People Also Ask about

Do I need to report dependent care FSA on taxes?

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.

Does the IRS require receipts for FSA expenses?

Please save your receipts and other supporting documentation related to your HC FSA expenses and claims. The IRS may request itemized receipts to verify the eligibility of your expenses. Credit card receipts, canceled checks, and balance forward statements do not meet the requirements for acceptable documentation.

Do I need a receipt for dependent care FSA?

How Dependent Care FSAs Work. Once you have paid for expenses that qualify for reimbursement from the FSA, you will need to complete a claim form provided by your employer and attach receipts or proof of payment with the form.

Do I need a receipt to claim dependent care FSA?

Supporting documentation for your claim should be an itemized statement from the dependent care provider that includes: service date(s), the dependent's name, the type of service, amount billed, and provider's name and address. You may not submit a canceled check as supporting documentation.

How do I get money from my dependent care account?

You must submit a claim each time you request reimbursement for dependent care expenses, even if you regularly pay your dependent care provider the same amount each week. You will be reimbursed up to the current amount in your DCFSA at the time your claim is processed.

What is the downside to dependent care FSA?

Drawbacks of Dependent Care FSA If money is left over at the end of the year, it doesn't carry over to the next year. If your employer doesn't offer this account, there is no other way to get one. Your FSA can only pay for qualifying expenses, while you're working.

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.

For pdfFiller’s FAQs

What is Dependent Care Spending Account Claim Form?

The Dependent Care Spending Account Claim Form is a document used by employees to request reimbursement for eligible dependent care expenses, allowing them to use pre-tax dollars for such expenses.

Who is required to file Dependent Care Spending Account Claim Form?

Employees who have enrolled in a Dependent Care Spending Account and have incurred eligible dependent care expenses are required to file this claim form to receive reimbursement.

How to fill out Dependent Care Spending Account Claim Form?

To fill out the Dependent Care Spending Account Claim Form, provide your personal information, details of the dependent care provider, the dates of service, and the amounts paid. Ensure to attach any required documentation such as receipts or invoices.

What is the purpose of Dependent Care Spending Account Claim Form?

The purpose of the Dependent Care Spending Account Claim Form is to facilitate the process of reimbursing employees for eligible dependent care expenses, thereby allowing employees to effectively manage their dependent care costs using pre-tax funds.

What information must be reported on Dependent Care Spending Account Claim Form?

The information that must be reported includes the employee's name, contact information, details about the dependent care provider, the dates the service was provided, the total amount paid, and any receipts or supporting documentation.