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Office Use Only Date Processed: / Processed by: / Client #: Reflex Form #21Medical FSA, Dependent Care FSA & Health Reimbursement Arrangement Claim Form PLEASE COMPLETE THIS FORM AND FAX IT ALONG
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Date processed refers to the date on which a particular task or transaction was completed or finalized.
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The purpose of date processed is to provide a clear timeline of when tasks or transactions were finalized for record-keeping and tracking purposes.
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The information required to be reported on date processed includes the specific date of finalization for a task or transaction.
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