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P.O. Box 1392 Addison, TX 750011292 Phone: Fax: (888) 4831392 (888) 2111392 Cafeteria Plan Dependent Care Claim For Accused Office Use: Date Received: By: Part 1 Employee Information Employer Name:
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How to fill out the new dep care formdoc?

01
Start by obtaining the new dep care formdoc from your employer or the appropriate department.
02
Carefully read through the instructions provided on the formdoc to understand the required information and sections to be filled.
03
Begin by providing personal information, such as your full name, contact details, and employee identification number, if applicable.
04
Provide details about your dependent, including their full name, date of birth, relationship to you, and any relevant medical or special needs they may have.
05
Indicate the type of dependent care service you are seeking, such as daycare, in-home care, or after-school programs, and provide the necessary details, including the name and address of the care provider.
06
If applicable, specify the desired start and end dates for the dependent care services.
07
Carefully review the formdoc to ensure all sections are completed accurately and that you have provided all necessary information.
08
Sign and date the formdoc to certify its accuracy and completeness.
09
Submit the completed formdoc to the appropriate department or individual within your organization as directed.
10
Keep a copy of the filled-out formdoc for your records.

Who needs the new dep care formdoc?

01
Employees who require dependent care services and wish to seek financial assistance or other benefits provided by their employer.
02
Individuals who have dependent(s) such as children or disabled family members that require care while they are at work or unable to provide care themselves.
03
Employers who offer dependent care benefits or assistance programs to their employees.
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The new dep care formdoc is a document used to report dependent care expenses for tax purposes.
Individuals who have dependents and incur dependent care expenses are required to file the new dep care formdoc.
To fill out the new dep care formdoc, you need to provide information about the dependent care expenses you incurred during the tax year.
The purpose of the new dep care formdoc is to report and claim the dependent care expenses you incurred for tax benefits.
You must report the amount of dependent care expenses you incurred, the name and address of the care provider, and any other relevant information.
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