Get Conexis Dependent Care Fsa Form - Hr@depaul.edu

Completing the Conexis Dependent Care FSA Form is an important step in managing your dependent care expenses. This guide provides detailed instructions to help you accurately fill out the form online, ensuring you receive the appropriate reimbursement for your eligible expenses.

Follow the steps to accurately complete your form

1. Press the ‘Get Form’ button to access the form. This will allow you to open the document in the online editor.
2. Fill in the employee information section. Ensure you provide your name, address, email, account number or Social Security number, and daytime phone number.
3. Complete the claim details by providing information about the dependent care provider. This includes the name and address of the provider, the dependent's name, date of birth, and the provider's tax identification number.
4. List the dates of service along with the requested amounts for each eligible expense. Confirm that each date of service falls within the plan year.
5. In the provider certification section, check the appropriate box to indicate whether both yours and the provider's certifications have been signed. If not, prepare to attach an itemized statement from the provider.
6. Organize all supporting documentation in the order listed on the form. Avoid using highlighters; instead, circle specific expenses on receipts as needed.
7. Sign and date the form, certifying that all information provided is accurate and that you are aware of the reimbursement rules.
8. Submit the completed form along with any copies of supporting documentation. Keep the original documents for your records.
9. Lastly, ensure that you have all necessary documents ready to fax, mail, or submit through any designated online means to finalize your reimbursement request.

Complete your Conexis Dependent Care FSA Form online now to manage your dependent care expenses effectively.