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Get Fsafeds Dependent Care Fsa Claim Form
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How to fill out the FSAFEDS Dependent Care FSA Claim Form online
Filling out the FSAFEDS Dependent Care FSA Claim Form online can significantly streamline your reimbursement process for dependent care expenses. This guide will walk you through each part of the form to ensure a smooth submission.
Follow the steps to complete your claim form accurately.
- Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
- Begin by completing 'Employee Information' in Section 1, using capital letters. You can use your User ID instead of your Social Security Number. Ensure you include your email and daytime phone number for correspondence.
- In Sections 2 and 5, for each expense, fill out a separate line. Avoid combining expenses. Provide the start date of service, amount requested, end date of service, and dependent’s date of birth.
- Ensure to attach supporting documentation, such as a bill or signed receipt. If unavailable, have the provider sign the affidavit on the relevant section.
- Read through the Certification in Section 3 thoroughly, affirming that the information is accurate, and then sign and date as required.
- Submit your completed form and supporting documentation. You can fax it to 1-866-643-2245 or mail it to FSAFEDS Program, PO Box 36880, Louisville, KY 40233.
- After submission, keep a copy of the completed form and receipts for your records.
Complete your FSAFEDS Dependent Care FSA Claim Form online today for a hassle-free reimbursement experience.
You can submit a claim to your FSA by completing the FSAFEDS Dependent Care FSA Claim Form. Be sure to attach any necessary documentation, such as receipts or invoices that verify your expenses. Once you have all your information ready, submit it according to your FSA's submission guidelines to receive the reimbursement promptly.
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