Get the free FSA Debit Card Substantiation Form - BMS LLC

FSA/HRA Debit Card Substantiation Form Name Employer Social Security# Day Phone Your e-mail Address (for claim-related matters only) Although up to 80% of debit card swipes are auto-substantiated

How to fill out fsa debit card substantiation

How to fill out fsa debit card substantiation:

1. Gather all necessary documentation, including receipts and explanation of benefits (EOBs) from your healthcare provider.
2. Review your fsa debit card transactions and identify any expenses that require substantiation.
3. Determine the type of substantiation required for each transaction. This can vary depending on the nature of the expense.
4. Fill out the fsa debit card substantiation form provided by your employer or fsa administrator. Provide accurate information about the transaction, including the date, merchant, amount, and the purpose of the expense.
5. Attach the supporting documentation, such as receipts or EOBs, to the substantiation form. Make sure they are legible and include all necessary information.
6. Double-check all the information you have entered on the form and review the attached documentation for accuracy.
7. Submit the completed fsa debit card substantiation form with the supporting documentation to your employer or fsa administrator according to the designated submission method (e.g., online, mail, fax).
8. Retain a copy of the substantiation form and supporting documentation for your records.

Who needs fsa debit card substantiation:

1. Individuals who have a flexible spending account (FSA) with a debit card feature may need to provide substantiation for certain expenses paid using the card.
2. Employers or fsa administrators may require substantiation to verify that the expenses charged to the fsa debit card are eligible under the IRS guidelines.
3. Substantiation is typically needed for expenses that are deemed potentially ineligible or require additional documentation to confirm their eligibility for reimbursement from the FSA.

For pdfFiller’s FAQs

What is fsa debit card substantiation?

FSA debit card substantiation is the process of providing proof of eligible expenses paid for with a Flexible Spending Account (FSA) debit card.

Who is required to file fsa debit card substantiation?

FSA participants are required to file fsa debit card substantiation.

How to fill out fsa debit card substantiation?

To fill out fsa debit card substantiation, you need to submit receipts or documentation to prove that the expenses are eligible under the FSA.

What is the purpose of fsa debit card substantiation?

The purpose of fsa debit card substantiation is to ensure that the expenses claimed are in compliance with FSA rules and regulations.

What information must be reported on fsa debit card substantiation?

The information that must be reported on fsa debit card substantiation includes the date of the expense, the amount, the merchant name, and a description of the expense.

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