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SHEET METAL WORKERS LOCAL UNION 268 WELFARE PLAN HEALTH REIMBURSEMENT ARRANGEMENT (HRA) REIMBURSEMENT CLAIM FORM Member Information: NameTelephone NumberSocial Security Number AddressCityStateOFFICE
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Start filling out the form by entering your personal information in the designated fields. This may include your name, address, contact number, etc.
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Provide details of the expenses you are claiming for, such as medical bills, prescriptions, or any other eligible expenses.
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HRA (House Rent Allowance) recipients who want to claim reimbursement for eligible expenses can use the hra-final-claim-form.docx.
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The hra-final-claim-formdocx is a form used to claim reimbursement for eligible expenses under an HRA plan.
Employees who have incurred eligible expenses and wish to be reimbursed through their HRA plan are required to file the hra-final-claim-formdocx.
The hra-final-claim-formdocx should be filled out completely and accurately, providing details of the expenses incurred and any supporting documentation as required.
The purpose of hra-final-claim-formdocx is to request reimbursement for eligible expenses paid by the employee out-of-pocket.
The hra-final-claim-formdocx must include details of the expenses incurred, date of purchase, name of the service provider, amount paid, and any supporting documentation.
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