Get Umr Dependent Care Claim Form - Rose-hulman - Msoe

Filling out the UMR Dependent Care Claim Form is a straightforward process that ensures you can request reimbursement for eligible dependent care expenses. This guide walks you through each section of the form to help you submit your claim accurately and efficiently.

Follow the steps to properly fill out the UMR Dependent Care Claim Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete section B with your employee information, including your identification number, name, address, employer, phone number, and email address.
3. In section C, provide details about your dependent care expenses. List the dates of service, the daycare provider's name and Tax ID number, and include the amount requested for each service.
4. Make sure to have the daycare provider sign the form to verify that the services were indeed incurred.
5. Sum the amounts in section C to get the total reimbursement request and fill it in the designated field.
6. In section D, sign and date the certification statement, affirming that the expenses meet the necessary conditions for reimbursement.
7. After completing the form, ensure you have the required documentation, such as itemized bills, and submit everything according to the instructions given.
8. Finally, save changes, download, print, or share the form as necessary to keep a record of your submission.

Start filling out your UMR Dependent Care Claim Form online today to ensure a smooth reimbursement process.