# of Pages Transmitted Killeen Independent School District Section 125 Flexible Benefit Plan DEPENDENT CARE REIMBURSEMENT REQUEST "Please Print" Name of Employee: SSN: (required) Address:.
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How to fill out the Kaznection online
Filling out the Kaznection form digitally can streamline your reimbursement process while ensuring accuracy. This guide offers a clear, step-by-step approach to completing the Dependent Care Reimbursement Request efficiently.
Follow the steps to successfully complete the Kaznection form
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the name of the employee in the designated field. This should be the name of the individual who is requesting reimbursement.
- Provide the social security number (SSN) of the employee in the required section, as this information is mandatory for processing.
- Fill in the address of the employee, including street address, any address change details, city, state, and zip code.
- Include the email address for correspondence related to this request.
- In the 'Expense Information' section, list each expense for which you are seeking reimbursement. Ensure the details pertain to qualifying expenses incurred for dependent care.
- For each expense, provide the dates of service, the total amount requested, the provider's name, dependent's name, and the age of the dependent.
- Make sure to include the provider's tax identification number and their signature to validate the request.
- Review the participant acknowledgment statement, confirming that all information is accurate and that you have not been reimbursed for the expenses from another source.
- Sign and date the form to certify the accuracy of the information submitted.
- Lastly, save your changes, and consider options to download, print, or share the completed form as needed before submission.
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