Get Dependent Care Receipt
Instructions: This form may be used by a caregiver or provider of service as a receipt for qualified dependent care services provided. Be sure to provide all information requested by this form. If the form is incomplete, it will be returned to you. Print or type the information requested. Then date and sign the form. Send this form along with the Dependent Care Reimbursement Request Form to: MedBen, Specialty Services Unit, P. O. Box.
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How to fill out and sign reimbursement online?
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- Select Done in the top right corne to save or send the record. There are many alternatives for getting the doc. As an instant download, an attachment in an email or through the mail as a hard copy.
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