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FLEXIBLE SPENDING ACCOUNT DEPENDENT CARE EXPENSE CLAIM FORM FAX TO: 303-221-2785 IT IS NOT NECESSARY TO INCLUDE A COVER SHEET PLAN & EMPLOYEE INFORMATION Check here if you have an address change FIRST
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What is dependent care claim form?
Dependent care claim form is a form used to request reimbursement for expenses related to the care of dependents, such as child or elder care.
Who is required to file dependent care claim form?
Individuals who have incurred eligible dependent care expenses and wish to seek reimbursement from their employer's dependent care assistance program or a similar program are required to file the dependent care claim form.
How to fill out dependent care claim form?
To fill out the dependent care claim form, you need to provide your personal information, details of the dependent(s) being cared for, the name of the care provider, the dates and costs of care, and any supporting documentation required by the program.
What is the purpose of dependent care claim form?
The purpose of the dependent care claim form is to document and request reimbursement for eligible dependent care expenses incurred by an individual.
What information must be reported on dependent care claim form?
The dependent care claim form typically requires information such as the individual's name and contact information, dependent's name and age, care provider's name and contact information, dates and costs of care, and any supporting documentation.
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