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This form is used to request reimbursement for medical and dependent care expenses incurred by participants of the Concordia University Section 125 Plan.

How to fill out medical care and dependent

How to fill out MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM

1. Obtain the MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM from your employer or insurance provider.
2. Carefully read the instructions provided on the form.
3. Fill in personal information including your name, address, and employee ID at the top of the form.
4. List all medical expenses incurred, including the date of service, provider name, service description, and amount paid for each expense.
5. Attach copies of receipts and any supporting documents for each medical expense.
6. Complete the section for dependent care expenses by entering the name of the caregiver, their address, and the amount paid.
7. Sign and date the form certifying that the information is accurate.
8. Submit the completed form and attached documents to the appropriate claims department as indicated in the instructions.

Who needs MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM?

1. Employees seeking reimbursement for out-of-pocket medical expenses.
2. Individuals who pay for dependent care services while they work or look for work.
3. Families with dependents who require care and need to claim expenses for tax purposes.

People Also Ask about

Does the IRS ask for proof of child care expenses?

You need to be able to verify childcare expenses in case of an audit. If you don't have proof that you paid these expenses, you can't claim the credit. You don't have to bring the receipts to your tax pro or mail them with your return. Just keep them with your personal records for at least three years.

Does IRS verify child care expenses?

Do you have to show proof of childcare on taxes? You need to be able to verify childcare expenses in case of an audit. If you dont have proof that you paid these expenses, you cant claim the credit. You dont have to bring the receipts to your tax pro or mail them with your return.

How do I prove child care expenses on my taxes?

To complete Form 2441, you typically need the following information from your childcare provider: The name, address, and taxpayer identification number (TIN), social security number (SSN), or employer identification number (EIN) of the childcare provider. The total amount paid for childcare services during the tax year.

Do I have to report child care expenses?

Reporting on your tax return If you qualify for the credit, complete Form 2441, Child and Dependent Care Expenses and attach to Form 1040, U.S Individual Income Tax Return, Form 1040-SR, U.S. Tax Return for Seniors or Form 1040-NR, U.S. Nonresident Alien Income Tax Return.

What documentation is needed for a FSA claim?

Q: What documentation is required to verify the eligibility of my FSA expense? documentation containing 1) date of service, 2) type of service, 3) charged amount, 4) name of the provider, and 5) any insurance paid on the expense, if applicable, for each claim.

How do I claim dependent care expenses on my taxes?

Complete Form 2441: Child and Dependent Care Expenses and attach it to your Form 1040 to claim the Child and Dependent Care Credit. When you claim the CDCC on your tax return, you will be required to list information about the care provider, including their name, address, and taxpayer identification number.

Do I need a statement from daycare for taxes?

Daycare centers are required to provide parents with an annual daycare tax statement. This statement shows the total amount parents spent on child care costs during the past year. These annual receipts should cover January 1st through December 31st of the previous year.

How to document dependent care FSA expenses?

When submitting a DCFSA claim, either have your dependent care provider certify the service by signing the claim form or provide an itemized statement from the dependent care provider that includes service dates, dependent's name, type of service, amount billed, and the provider's name and address along with a

For pdfFiller’s FAQs

What is MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM?

The MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM is a document used by individuals to submit claims for reimbursement of eligible medical and dependent care expenses incurred during a specific period.

Who is required to file MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM?

Individuals who have incurred medical or dependent care expenses and wish to seek reimbursement from their employer's health care or dependent care flexible spending account are required to file this form.

How to fill out MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM?

To fill out the form, gather all relevant receipts and documentation, clearly list each expense with date, amount, and description, and provide any necessary personal information, including the account number and signature.

What is the purpose of MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM?

The purpose of the form is to facilitate the reimbursement process for eligible medical and dependent care expenses, allowing individuals to recover costs associated with health or child care services.

What information must be reported on MEDICAL CARE and DEPENDENT CARE EXPENSE CLAIM FORM?

The form must include personal identification details, the type of expense, date of service, total amount, provider information, and any relevant documentation or receipts proving the expenses incurred.