Get Po Box 785040

Filling out the Po Box 785040 claim form can be a straightforward process if you follow the proper steps. This guide provides clear instructions to ensure that you complete the form accurately and submit it effectively.

Follow the steps to complete the Po Box 785040 claim form

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by filling in your name in the format of Last/First/Middle Initial. This step is essential as it identifies you as the claimant.
3. Enter your Social Security Number. This information is necessary for verification purposes.
4. Fill in your address, including Street, City, State, and Zip Code. Make sure that this information is current and accurate.
5. Provide your daytime telephone number, as this will allow the processing team to contact you if there are any questions regarding your claim.
6. For health care claims, record the date of service in the specified format (mm-dd-ccyy), and provide the name of the service provider.
7. Indicate the type of service you are claiming by checking the appropriate box (Prescription, Over-the-Counter Drugs, Medical, Dental, Vision, Hearing).
8. Enter the patient’s name for whom the service was provided and the requested amount for each service. Make sure to sum these amounts in the Health Care Total field.
9. If you are claiming for dependent care, fill in the dates of service, the service provider’s name, the name of the dependent, and the requested amounts as you did for health care claims.
10. Attach any original receipts that support your claims. Ensure you have included all the fields accurately and sign the form.
11. Submit your claim by faxing it to 1-888-211-9900 or mailing it to the specified address: Your Spending Account, P.O. Box 785040, Orlando, FL 32878-5040.
12. Finally, remember to save your changes, and if needed, download or print the form for your records.

Complete your claims online today for a seamless experience.