Get the free DEPENDENT CARE FSA CLAIM FORM - Independent Pension

Return the completed Claim Form and documentation to: Toni Ann Mature, Benefits Administrator Independent Pension Services, Inc. 114 Old Country Rd., Ste. 520, Mineral, NY 11501 Phone: 5167475210

How to fill out dependent care fsa claim

How to fill out dependent care FSA claim:

1. Begin by gathering all necessary documentation related to the dependent care expenses you incurred. This may include receipts, invoices, statements, or any other documents that provide proof of the expenses.
2. Access the website or online portal of your dependent care FSA provider. If you don't have an online option, request a paper claim form from your FSA administrator.
3. Fill out the claim form with accurate and detailed information. Include your personal details, such as name, address, and FSA account number.
4. Provide the necessary information about the dependent care provider, such as their name, address, and tax identification number (TIN).
5. Clearly indicate the time period during which the dependent care services were provided. This could include specific dates, a range of dates, or the duration of the care.
6. Summarize the expenses incurred for dependent care by entering the total amount spent within the specified time period. Ensure that this amount matches the documentation you have gathered.
7. Attach all relevant receipts, invoices, or other supporting documents to the claim form. It's essential to keep copies of these documents for your personal records as well.
8. Review the completed claim form and attached documents to verify accuracy and completeness. Make any necessary corrections or additions before submitting.
9. Submit your claim form and supporting documents to your FSA administrator. Follow their specific instructions for submission, whether it's through mail, upload, or online submission.
10. Keep track of when your claim was submitted and follow up with your FSA administrator if needed. It's advisable to keep copies of all correspondence related to your claim for future reference.

Who needs dependent care FSA claim:

1. Individuals who have dependents, such as children under the age of 13 or disabled individuals requiring care, may need to file a dependent care FSA claim.
2. Employees who have enrolled in a dependent care FSA through their employer's benefits program will typically need to submit claims to access the funds set aside in their FSA account.
3. Those who have incurred eligible dependent care expenses, such as daycare, nanny fees, before or after-school programs, or elder care, can benefit from filing a dependent care FSA claim to receive reimbursement.

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