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Flexible Spending Account Claim Form Health Care & Dependent Airmail or Fax completed form and documentation to: Inspire Financial PO Box 2495 Omaha, NE 68103 Fax: 8882383539-Page 1 onto help avoid
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What is cdb-004 fsa claim form?
The CDB-004 FSA claim form is a document used to file a claim for eligibility or reimbursement for benefits under the Flexible Spending Account (FSA) program.
Who is required to file cdb-004 fsa claim form?
Employees who have incurred eligible expenses under their Flexible Spending Account and wish to claim reimbursement must file the CDB-004 FSA claim form.
How to fill out cdb-004 fsa claim form?
To fill out the CDB-004 FSA claim form, provide personal information, details of the expenses incurred, amount to be reimbursed, and any required documentation or receipts.
What is the purpose of cdb-004 fsa claim form?
The purpose of the CDB-004 FSA claim form is to enable employees to request reimbursement for qualified medical or dependent care expenses from their Flexible Spending Account.
What information must be reported on cdb-004 fsa claim form?
The CDB-004 FSA claim form must report information such as employee details, the type of expense, date of service, amount spent, and any attached receipts or proof of expense.
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