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FLEXIBLE SPENDING ACCOUNT (FSA) DEPENDENT CARE CLAIM FORM Plan Year 1/1/2016-12/31/2016 To request reimbursement from your FSA for a dependent care claim, please: Complete this form. Ask your dependent

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What is flexible spending account fsa?

Flexible Spending Account (FSA) is a tax-advantaged financial account that allows employees to set aside a portion of their earnings to pay for qualified expenses such as medical costs.

Who is required to file flexible spending account fsa?

Employees who wish to utilize the benefits of a Flexible Spending Account (FSA) are required to enroll in the program and contribute a portion of their pre-tax earnings towards it.

How to fill out flexible spending account fsa?

To fill out a Flexible Spending Account (FSA), employees need to enroll during their employer's open enrollment period and indicate the amount they wish to contribute from their earnings.

What is the purpose of flexible spending account fsa?

The purpose of a Flexible Spending Account (FSA) is to help employees save money on qualified expenses by setting aside pre-tax earnings in a dedicated account.

What information must be reported on flexible spending account fsa?

Flexible Spending Account (FSA) reports typically include employee contributions, qualified expenses paid out, and any remaining funds left in the account.

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