Get Wageworks Dependent Care Pay Me Back Claim Form - Nyu

Filing a claim for dependent care expenses can be a straightforward process when you have the right guidance. This guide will help you navigate the WageWorks Dependent Care Pay Me Back Claim Form, ensuring you provide all necessary information for successful processing.

Follow the steps to fill out the claim form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin with the account holder information. Fill out your legal name as recorded by your employer, your ID code (which is typically the last four digits of your Social Security Number), and your employer's name. Provide your birth date and zip code.
3. Indicate your email address only if it is a new one. This may assist in receiving claim updates.
4. In the certification and authorization section, read the statement carefully, ensuring all information is accurate and complete. Sign and date the form to certify your request for reimbursement.
5. List the out-of-pocket expenses for dependent care. For each expense, provide the necessary details: the type of care (child care, preschool, etc.), the name of the dependent, the relationship to you, the provider's name, service start and end dates, and the amount incurred.
6. Make sure to have the provider's signature on the claim form, or alternatively, include an itemized receipt from the provider. Note that a signature is not required to submit receipts.
7. Summarize the total amount on the form and ensure every expense is documented. If you have more expenses, be prepared to complete a separate form.
8. Once completed, review the form to confirm accuracy. Save your changes, then download, print, or share the form as needed for submission.

Complete your WageWorks Dependent Care Pay Me Back Claim Form online today for a smooth reimbursement process.