Get Uben 254 Form

The Uben 254 Form is used by academic student employees at the University of California to request reimbursement for eligible child care expenses. This guide will help you navigate through the process of filling out this form online, ensuring that you meet all requirements.

Follow the steps to successfully complete the Uben 254 Form online.

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Begin by entering your personal information, including your name, employee ID number, campus, and address. Ensure all details are accurate.
3. Enter your contact information by providing your home and work phone numbers.
4. In the dependents section, fill in the name, relationship, and birthdate for each dependent that qualifies for reimbursement.
5. Provide information about your child care provider, including their name, tax identification number, and service dates.
6. List the incurred expenses by providing the amounts you wish to be reimbursed for each dependent care provider. Attach the required documentation.
7. Indicate the total amount to be reimbursed at the end of this section.
8. Sign the form, certifying that the information provided is true and that you have incurred these expenses.
9. After completing the form, review all sections for accuracy, then save your changes. You can download, print, or share the completed form as needed.

Ensure you accurately complete your documents online to streamline the reimbursement process.