ProBenefits Dependent Care Receipt Form 2010 free printable template

Dependent Care Receipt Form THIS IS NOT A CLAIM FORM If your dependent care provider does not give you a receipt, have them complete and sign this form. You must submit a Reimbursement Claim Form

How to fill out ProBenefits Dependent Care Receipt Form

How to fill out ProBenefits Dependent Care Receipt Form

1. Obtain the ProBenefits Dependent Care Receipt Form from the ProBenefits website or your HR department.
2. Fill in your personal information at the top of the form, including your name, address, and employee ID number.
3. Enter the dates for which you are seeking reimbursement in the designated sections.
4. Record the total amount paid for dependent care services, ensuring the receipt is itemized if required.
5. Provide the name and contact information of the care provider.
6. Sign and date the form to certify that the information provided is accurate.
7. Submit the completed form along with any required receipts to ProBenefits according to their submission guidelines.

Who needs ProBenefits Dependent Care Receipt Form?

1. Employees who pay for qualifying dependent care expenses to allow them to work or look for work.
2. Parents or guardians of children under the age of 13 receiving care.
3. Individuals caring for a dependent who is physically or mentally incapable of self-care.

People Also Ask about

Is babysitting by your relative who is not a tax dependent?

Technically your mom or dad are independent contractors if they babysit at their house. But if someone babysits at yours, then they're considered a household employee, although you don't need to issue a W-2. You also don't need to withhold Medicare or social security (FICA) taxes—even if you pay them more than $2,400.

Is babysitting covered under dependent care FSA?

Can I get reimbursed from my Dependent Care FSA if I pay her for babysitting? Yes. As long as the relative providing care is not claimed by you or your spouse as a tax dependent, you can be reimbursed for amounts you pay them for care of your dependent.

What is not covered under dependent care FSA?

Amounts paid to a child of the dependent care FSA participant is not eligible for reimbursement. Clothing items are generally not eligible for reimbursement. The cost of custodial care for children under age 13 and adults incapable of self-care is eligible for reimbursement.

How do I claim my babysitter on FSA?

Dependent Care FSA reimbursements You'll likely need to complete a claim form provided by your employer and provide receipts or proof of payments. You may need to include: date of the expense (or service start and end dates) description of the service.

What receipt is needed for a dependent care FSA?

You will need an Itemized Receipt from the day care provider. The receipt must reference the from/through date of service and be signed by the provider (or on the provider's letterhead).

How do I claim babysitting expenses on dependent care FSA?

When submitting a Dependent Care receipt for care from a babysitter, you are required to provide the babysitter's name and address. For tax filing purposes, you are required to provide the babysitter's name, address and taxpayer identification number.

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What is ProBenefits Dependent Care Receipt Form?

The ProBenefits Dependent Care Receipt Form is a document used to claim reimbursement for dependent care expenses under a flexible spending account (FSA) or similar benefit program.

Who is required to file ProBenefits Dependent Care Receipt Form?

Individuals who have incurred qualified dependent care expenses and wish to seek reimbursement from their employer's benefits plan are required to file the ProBenefits Dependent Care Receipt Form.

How to fill out ProBenefits Dependent Care Receipt Form?

To fill out the ProBenefits Dependent Care Receipt Form, gather receipts for eligible dependent care expenses, provide information about the care provider, detail the services rendered, and submit the completed form along with the receipts.

What is the purpose of ProBenefits Dependent Care Receipt Form?

The purpose of the ProBenefits Dependent Care Receipt Form is to provide documentation and support for reimbursement requests related to dependent care costs, ensuring compliance with tax regulations and benefit plan requirements.

What information must be reported on ProBenefits Dependent Care Receipt Form?

The information that must be reported on the ProBenefits Dependent Care Receipt Form includes the name and address of the care provider, the tax identification number (TIN) of the provider, dates of service, the amount paid, and details about the dependents being cared for.