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Health Plan Alternatives Agency, Inc. P.O. Box 884 Westerville, Ohio 43081 (800) 898-8262 (614) 890-8262 Reimbursement Request Form for Section 125 Cafeteria Plan (Please print) Participant s Name:
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What is reimbursement request form for?
The reimbursement request form is used to request reimbursement for expenses incurred on behalf of an organization or company.
Who is required to file reimbursement request form for?
Employees or individuals who have incurred expenses on behalf of an organization or company are required to file a reimbursement request form.
How to fill out reimbursement request form for?
To fill out a reimbursement request form, one must provide details of the expenses incurred, including the date, amount, and purpose of the expense.
What is the purpose of reimbursement request form for?
The purpose of a reimbursement request form is to track and reimburse individuals for expenses incurred on behalf of an organization or company.
What information must be reported on reimbursement request form for?
Information such as the date of the expense, amount spent, purpose of the expense, and supporting documentation must be reported on a reimbursement request form.
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