Get the free Dependent Care Assistance Plan Change Form

This form allows employees to make changes to their DCAP payroll deductions due to qualifying life events as per IRS guidelines.

How to fill out dependent care assistance plan

How to fill out Dependent Care Assistance Plan Change Form

1. Obtain the Dependent Care Assistance Plan Change Form from your HR department or employee portal.
2. Fill out your personal information, including your name, employee ID, and contact information.
3. Specify the reason for the change in the designated section of the form.
4. Provide details regarding the dependent care provider, including their name, address, and contact information.
5. Indicate the start and end dates for the change being requested.
6. Review the form for accuracy and completeness.
7. Sign and date the form at the bottom.
8. Submit the form to your HR department as instructed, either electronically or in person.

Who needs Dependent Care Assistance Plan Change Form?

1. Employees who are currently enrolled in a Dependent Care Assistance Plan and need to make a change to their dependent care arrangement.
2. Individuals who have experienced a qualifying life event, such as a change in childcare provider or changes in their dependent's status.

People Also Ask about

Can I contribute to dependent care in FSA?

If both you and your spouse participate in a dependent care FSA the total household contribution is limited to $5,000. If you file as “Head of Household”, the IRS maximum contribution is $5,000. If you use the “Married Filing Separately” tax filing status, the IRS limits contributions to $2,500.

Can you change your FSA contribution?

Yes, you may change your election and allotment amount (FSA contribution) as often as you want during the Open Season timeframe . Your last change as of midnight Eastern Time on the day Open Season ends becomes your final election.

What are the drawbacks of dependent care FSA?

Cons of a Flexible Spending Account Use-It-Or-Lose-It Rule: Unused FSA funds are forfeited unless your employer offers a grace period or carryover option. Eligibility Restrictions: FSAs only cover qualifying medical expenses, dental and vision costs, and dependent care expenses.

For pdfFiller’s FAQs

What is Dependent Care Assistance Plan Change Form?

The Dependent Care Assistance Plan Change Form is a document used by employees to make changes to their dependent care assistance benefits, allowing them to adjust their contributions or enrollment in the dependent care assistance plan.

Who is required to file Dependent Care Assistance Plan Change Form?

Employees who wish to modify their dependent care assistance benefits, including changes due to life events like marriage, birth of a child, or other qualifying events, are required to file the Dependent Care Assistance Plan Change Form.

How to fill out Dependent Care Assistance Plan Change Form?

To fill out the Dependent Care Assistance Plan Change Form, employees should provide personal information, details about their current dependent care plan, the changes they wish to make, and any relevant supporting documentation as required by their employer.

What is the purpose of Dependent Care Assistance Plan Change Form?

The purpose of the Dependent Care Assistance Plan Change Form is to enable employees to formally request changes to their dependent care benefit selection, reflecting personal or family situations and ensuring adequate financial support for dependent care expenses.

What information must be reported on Dependent Care Assistance Plan Change Form?

The information that must be reported on the Dependent Care Assistance Plan Change Form typically includes the employee's name, identification number, the type of change being requested, details of the dependent care provider, and any necessary documentation to support the request.