Get Recurring Dependent Care Request Form - Ehorton

Filling out the Recurring Dependent Care Request Form - EHorton is an important step in managing your dependent care expenses. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently, ensuring that you can receive your reimbursements without delay.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by providing your participant information. Fill out the following required fields: Employer name (avoid abbreviations), Employee ID, Participant name (First, Middle Initial, Last), and Social Security Number. Ensure all information is accurate.
3. Move on to the Recurring Dependent Care Account (DCA) information section. Indicate your request by selecting one of the options: to start, change, or stop recurring DCA. Provide the dependent's name, date of birth, start date of service, and end date of service, all of which must fall within the current plan year.
4. Next, fill in the Dependent Care Provider Information and Signature section. Provide the provider's name, cost per month/week, and ensure the provider's signature is included to confirm the accuracy of the information. If there is more than one provider, repeat the fields as necessary.
5. Finally, complete the Participant Certification section. Confirm that the information provided is complete and accurate. Acknowledge the requirements regarding documentation and liability on the part of Discovery Benefits. Provide the necessary tax identification number (TIN) if applicable.
6. After reviewing all the information for accuracy, save your changes. You may now download, print, or share the completed form as needed.

Take action now and complete your Recurring Dependent Care Request Form online for timely reimbursements.