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Get Monthly Dependent Care Claim Form
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How to fill out the Monthly Dependent Care Claim Form online
Filling out the Monthly Dependent Care Claim Form online can be a straightforward process if you follow the correct steps. This guide aims to provide clear instructions for each section of the form, ensuring you submit your claim accurately and efficiently.
Follow the steps to complete your claim form online:
- Click the ‘Get Form’ button to access the claim form and open it in your preferred online editor.
- Begin by entering your employee information in the designated fields. This includes your name, company name, the last four digits of your Social Security number, your telephone number, and your email address.
- In the below section, complete the table with the names of the service recipients, their ages, the date of service (both start and end), the service provider’s name, and the total cost of the service.
- Ensure all itemized bills and receipts from your dependent care provider are included. These documents must contain the required information: service dates, provider's name, recipient's name, recipient's age (if under 13), and the service cost.
- If you opt not to provide an itemized receipt, have your dependent care provider fill out the Certification From Provider section to validate the services provided.
- Sign and date your claim form in the designated areas to confirm the accuracy of your submission.
- Lastly, save changes to your form, then choose to download and print it. You may also share it or send it via fax to the provided number or mail it to the address indicated.
Complete your claims online today for a seamless reimbursement experience.
An employer must still follow the "use it or lose it" rule for dependent care FSA funds. A dependent care FSA plan allows for a reasonable time for employees to submit claims after the plan year-end, but all dependent care expenses must be incurred by plan year-end.