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Use the Health Choices Flex Mobile App to submit your reimbursement request with the snap of a photo. Or log on to https://myflexconsumer.lh1ondemand.com to upload receipts and submit claims. Dependent
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How to fill out dependent care expense claim

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How to fill out dependent care expense claim

01
Obtain the dependent care expense claim form from your employer or insurance provider.
02
Fill in your personal information, including your name, address, and employer information.
03
Provide information about your dependent, including their name, age, and relationship to you.
04
Detail the expenses you incurred for dependent care, including the dates of service and the amount paid.
05
Attach any supporting documentation, such as receipts or invoices, to prove the expenses.
06
Sign and date the form before submitting it to the appropriate party for reimbursement.

Who needs dependent care expense claim?

01
Employees who have dependents such as children, elderly parents, or disabled family members and incur expenses for their care.
02
Individuals who have a flexible spending account (FSA) or dependent care assistance program through their employer.
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A dependent care expense claim is a tax benefit that allows individuals to claim expenses incurred for the care of a dependent (usually a child) while they are working or looking for work.
Individuals who incur expenses for the care of a qualifying dependent (such as a child under 13 or a disabled spouse) in order to work or look for work are required to file a dependent care expense claim.
To fill out a dependent care expense claim, you need to use IRS Form 2441, provide information such as the care provider's name, address, and taxpayer identification number, along with the total amount spent on care.
The purpose of the dependent care expense claim is to provide financial relief to working individuals by allowing them to deduct eligible expenses for the care of dependents.
You must report the name, address, and taxpayer identification number of the care provider, as well as the total amount of expenses incurred for the care of the dependent.
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