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ORIGINAL SUBMISSION RESUBMISSIONFlexible Spending Dependent Care Reimbursement Account Request A. INSTRUCTIONSComplete sections B, C, and D Please include an itemized bill or statement from your provider
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How to fill out flexible spending dependent care

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How to fill out flexible spending dependent care

01
Gather the necessary information, including the name, date of birth, and social security number of the dependent(s) for whom you are seeking dependent care reimbursement.
02
Keep track of your dependent care expenses, such as daycare costs, before-school and after-school programs, and summer camps.
03
Obtain a flexible spending dependent care reimbursement form from your employer or benefits provider.
04
Fill out the form accurately and completely. Provide the requested information for both the employee and the dependent(s), including dates of service, providers, and amounts paid.
05
Attach the relevant supporting documents, such as receipts, invoices, or statements, to substantiate your expenses.
06
Review the completed form and supporting documents to ensure everything is accurate and complete.
07
Submit the form and supporting documents to your employer or benefits provider as directed.
08
Keep copies of all submitted documents for your records.
09
Follow up with your employer or benefits provider to confirm receipt and inquire about the reimbursement timeline.
10
Reimbursement will typically be made directly to the employee, either through direct deposit or a check.
11
Keep track of the reimbursement for tax purposes, as it may need to be reported on your income taxes.
12
Repeat the process for each eligible reimbursement period.

Who needs flexible spending dependent care?

01
Flexible spending dependent care is beneficial for individuals who have eligible dependents, such as children under the age of 13 or disabled dependents.
02
Employed individuals who incur qualified dependent care expenses and want to reduce their taxable income may find flexible spending dependent care helpful.
03
This benefit can be especially advantageous for working parents who require ongoing child care services.
04
Those who anticipate incurring dependent care expenses within a specific reimbursement period and want to take advantage of tax-advantaged savings for these expenses may also benefit from flexible spending dependent care.
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Flexible spending dependent care refers to a tax-advantaged account that allows employees to set aside pre-tax dollars to pay for eligible dependent care expenses, such as childcare or care for elderly dependents.
Employees who have set up a flexible spending account (FSA) for dependent care expenses are required to file for reimbursement from their account when they incur eligible expenses.
To fill out a flexible spending dependent care claim, you typically need to complete a claim form provided by your employer or FSA administrator, include documentation of the expenses (such as receipts), and submit it by the specified deadline.
The purpose of flexible spending dependent care is to provide employees with a tax-effective way to pay for necessary dependent care services, helping to alleviate the financial burden of childcare or care for dependents.
When filing for flexible spending dependent care, you must report the names of the dependents receiving care, the type of services provided, the dates of service, and the total amount being claimed for reimbursement.
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