Get Transaction Substantiation Form - Flexible Benefit Administrators

Filling out the Transaction Substantiation Form is an essential step for users to claim eligible expenses related to medical care. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to successfully complete the Transaction Substantiation Form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred format for completing.
2. Begin by entering your general employee information. Provide your full name, Social Security number or employee ID, email address for notifications, and the name of your employer.
3. List your expenses systematically. For each eligible transaction, provide the date of the transaction, the name of the merchant, the type of eligible expense, and the amount of the transaction.
4. Once you have filled out all relevant fields for your expenses, ensure that you certify the accuracy of the information. This certification indicates that the expenses were incurred for valid medical reasons and that you have not been reimbursed yet.
5. Attach all necessary documentation, including itemized receipts or bills that substantiate your claims and ensure that they are relevant to the transactions listed. If applicable, include a letter of medical necessity for dual-purpose items.
6. Finally, sign and date the form to validate your submission. Once everything is complete, save your changes and retain a copy for your records.

Complete your Transaction Substantiation Form online today to ensure your eligible expenses are processed efficiently.