Get Fsa Dependent Care Request For Reimbursement. The Ohio State University Office Of Human Resources

Filling out the FSA Dependent Care Request For Reimbursement form is essential for obtaining reimbursement for eligible dependent care expenses. This guide will provide you with clear, step-by-step instructions to assist you in completing the form accurately and efficiently, ensuring prompt processing of your request.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the form and access it for editing.
2. Complete Section 1: Employee Information. Provide your full name, employee ID number, daytime phone number, and email address. Ensure that all information is accurate to prevent any processing delays.
3. In Section 2: Dependent Care Expenses, list each dependent care expense on a separate line. Record the service dates, total amount paid, amount to be reimbursed, the full name of the dependent, your relationship to the dependent, their age, the service provider's name, and either the provider's tax ID or social security number.
4. If you do not have a bill or receipt, ensure that the service provider signs the form in the designated area to confirm the expenses.
5. After completing the information, review all entries for accuracy, ensuring that you have listed no more than 10 expenses per form and that each expense is eligible according to IRS guidelines.
6. Sign and date Section 3: Participant Certification, confirming that you understand the terms and conditions, and that the information provided is accurate.
7. Attach the necessary receipts or itemized bills to the form as instructed, or ensure the provider's signature is included if you do not have the bills.
8. Save your changes to the document, and prepare to submit your request. You can download, print, or share the form as needed.

Complete your FSA Dependent Care Request For Reimbursement form online now for a smooth reimbursement process.