Get the free Dependent Care Reimbursement Request Form - accessKent

Dependent Care Reimbursement Request Form (DAY CARE) Submit claims to: Professional Benefits Services Flexible Spending Department 2959 Lucerne SE Suite 205 Grand Rapids, MI 49546 or Fax (855) 2961026

How to fill out dependent care reimbursement request

How to fill out dependent care reimbursement request?

1. Obtain the dependent care reimbursement request form from your employer or benefits administrator.
2. Fill out your personal information such as your name, employee ID, and contact information.
3. Provide details about the dependent for whom you are seeking reimbursement, including their name, age, and relationship to you.
4. Attach any necessary supporting documentation, such as receipts or invoices, which show the expenses incurred for the dependent care.
5. Indicate the time period for which you are seeking reimbursement, including the start and end dates.
6. Calculate the total amount of dependent care expenses and enter it on the reimbursement request form.
7. Sign and date the form, acknowledging that the information provided is accurate and true to the best of your knowledge.
8. Submit the completed reimbursement request form to your employer or benefits administrator, following any specific instructions they may have provided.

Who needs dependent care reimbursement request?

1. Employees who have dependents, such as children or disabled family members, and incur expenses for their care.
2. Individuals who are enrolled in a dependent care reimbursement account or a flexible spending account (FSA) that allows for reimbursement of dependent care expenses.
3. Caregivers who have been authorized to receive reimbursement for their services through a dependent care reimbursement program offered by their employer.

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What is dependent care reimbursement request?

Dependent care reimbursement request is a request for reimbursement of expenses incurred for dependent care services, such as childcare or elder care.

Who is required to file dependent care reimbursement request?

Employees who have dependent care expenses and are enrolled in a dependent care reimbursement account are required to file a dependent care reimbursement request.

How to fill out dependent care reimbursement request?

To fill out a dependent care reimbursement request, employees need to provide details of the expenses incurred for dependent care services, including the name of the provider, dates of service, and amount paid.

What is the purpose of dependent care reimbursement request?

The purpose of dependent care reimbursement request is to request reimbursement for expenses incurred for dependent care services, allowing employees to receive tax-free reimbursement for eligible expenses.

What information must be reported on dependent care reimbursement request?

The dependent care reimbursement request must include details of the dependent care provider, dates of service, amount paid, and any other relevant information to support the reimbursement request.