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ResetPrintSave1475 Kendall Blvd., PO Box 2560
East Lansing, MI 488262560
800.890.0393
Fax: 517.333.6258OptionALLDependent Care Spending Account Plan
Withdrawal Request
Part 1EMPLOYEE INFORMATION (Please
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What is fsa generic claim form?
The FSA generic claim form is a form used to request reimbursement for eligible expenses under a flexible spending account (FSA).
Who is required to file fsa generic claim form?
Employees who participate in a flexible spending account (FSA) are required to file the generic claim form in order to receive reimbursement for eligible expenses.
How to fill out fsa generic claim form?
To fill out the FSA generic claim form, employees must provide details of the expenses incurred, including the date, amount, and nature of the expense.
What is the purpose of fsa generic claim form?
The purpose of the FSA generic claim form is to request reimbursement for eligible expenses paid for out-of-pocket by participants in a flexible spending account (FSA).
What information must be reported on fsa generic claim form?
The FSA generic claim form must include details of the expenses incurred, such as the date, amount, and nature of the expense, as well as any supporting documentation.
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