Follow the steps to complete the HRA Form online

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Begin by providing your company name and employee social security number in the designated fields.
3. Fill in your name and indicate if there has been a change of address by selecting 'Yes' if applicable. Complete your street address, city, state, and zip code.
4. Enter your work phone number and home phone number, including the area code for both.
5. In the 'Health Care Expenses' section, attach supporting documentation as specified. You can provide either an Explanation of Benefits (EOB) or itemized receipts for claims.
6. Record the date the expense was incurred using the format MM/DD/YYYY, the name of the service provider, and a brief description of the expense.
7. Indicate the patient name and the amount of reimbursement requested for each expense listed.
8. Sum up the total reimbursement amount at the bottom of the specified area.
9. Ensure you sign and date the form, certifying that the information provided is correct and that you have not claimed the expenses through any other source.
10. Finally, review all entered information for accuracy before saving your changes, downloading, printing, or sharing the completed form.

Complete your HRA Form online today to ensure timely reimbursement of your healthcare expenses.