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DEPENDENT CARE EXPENSE CLAIM FORM Mail to: UPMC Health Plan PO Box 3169 Greenwood Village, CO 80155-3169 Phone: 1-888-876-2756 Fax: 1-866-229-3711 No. of pages PLAN & EMPLOYEE INFORMATION FIRST NAME:

How to fill out dependent care expense claim

How to fill out dependent care expense claim:

1. Gather necessary documents: Before filling out the claim form, collect all the relevant documents such as receipts, invoices, and any other proofs of your dependent care expenses.
2. Complete personal information: Start by entering your personal details like your name, address, social security number, and contact information. This information is vital for identification purposes.
3. Provide dependent information: In this section, specify the details of the dependent(s) for whom you incurred care expenses. Include their full name, date of birth, relationship to you, and social security number.
4. State care provider details: Next, include the information of the care provider(s) responsible for looking after your dependent(s). Include their name, address, and tax identification number (if applicable). If the care provider is an individual, you may also need their social security number.
5. Indicate the time period and type of care: Specify the time period during which the care was provided by indicating the start and end dates. Additionally, describe the type of care received, such as daycare, summer camp, or after-school programs.
6. Calculate expenses: Enter the total amount of eligible dependent care expenses you incurred during the specified time period. Ensure that the expenses are related to the care of your dependent and are supported by the appropriate documentation.
7. Verify eligibility: Double-check whether the expenses you are claiming meet the eligibility criteria set by the IRS. Generally, expenses for dependent care that enable you to work or seek employment may be eligible for reimbursement.
8. Sign and date: Once you have filled out the form completely, sign and date it to certify the information provided is accurate to the best of your knowledge.

Who needs dependent care expense claim?

1. Individuals with dependents: Anyone who has dependents, such as children or disabled family members, may need to fill out a dependent care expense claim. This claim allows them to seek reimbursement for qualified care expenses incurred while they work or look for employment.
2. Employees with dependent care benefits: If you have an employer-provided dependent care flexible spending account (FSA) or any other dependent care benefit program, you may be required to submit a dependent care expense claim to access the funds allocated for dependent care expenses.
3. Taxpayers seeking tax deductions or credits: In certain cases, taxpayers who have incurred eligible dependent care expenses may claim tax deductions or credits. Filing a dependent care expense claim can help support these deductions or credits when completing your tax return.

Note: It is important to consult with a tax professional or refer to the specific guidelines provided by your employer or the tax authority in your country to ensure you follow all the necessary steps and meet the requirements when filling out a dependent care expense claim.

For pdfFiller’s FAQs

What is dependent care expense claim?

Dependent care expense claim is a form filed by taxpayers to claim expenses paid for the care of dependents.

Who is required to file dependent care expense claim?

Taxpayers who have dependents and have paid for dependent care expenses are required to file a dependent care expense claim.

How to fill out dependent care expense claim?

To fill out a dependent care expense claim, taxpayers must provide information about the dependents, the care provider, and the expenses paid for the care.

What is the purpose of dependent care expense claim?

The purpose of dependent care expense claim is to allow taxpayers to claim a tax credit or deduction for expenses paid for the care of dependents.

What information must be reported on dependent care expense claim?

Information such as the names and ages of the dependents, the care provider's name and address, and the total expenses paid for dependent care must be reported on the dependent care expense claim.

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