The tax break you can t afford to ignore review the instructions to submit your claim! Please print or type in all caps. Include your Social Security Number, name, daytime phone, and name of employer. Be sure to sign and date your claim form. Provide the tax ID or SSN and name of the daycare provider. Please complete one line for consecutive dates of care. Incomplete claim forms may result in claim denial or a request for more information. This form allows you to submit up to four (4) e.
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How to fill out the Benesyst Portal online
The Benesyst Portal provides a seamless way to submit your Flexible Spending Account Daycare Reimbursement Request Form. This guide will walk you through each step to ensure your submission is complete and accurate.
Follow the steps to successfully complete your online reimbursement request.
- Click ‘Get Form’ button to obtain the Daycare Reimbursement Request form and open it for editing.
- Fill in your personal information, including your Social Security Number, full name, daytime phone number, and employer's name. Be sure to print or type in all capital letters.
- Provide the daycare provider's tax ID or Social Security Number and their name. Ensure all fields are completed accurately.
- List the dates of care, ensuring that you complete one line for consecutive dates. You can submit up to four expense claims per form; use a new form for each additional dependent.
- Total the sum of all line items on the claim form and include an itemized documentation page where you attach one receipt or item for each page.
- Sign and date your claim form. Ensure all information is correct and complete before submission.
- Fax the claim form and all documentation to Benesyst at the number provided. Utilize the Documentation Page for any smaller itemized receipts.
- Once the form is faxed, keep a complete copy of your claim for your records. You may also save changes, download, print, or share your form as needed.
Take the first step towards reimbursement and start filing your claims online today.
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Aug 12, 2019 — card is deactivated, 2019 claims may be submitted to TASC via the web...
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