Get Dependent Care Fsa Claim Form - Bpas

This guide provides clear and supportive instructions on how to fill out the Dependent Care FSA Claim Form - BPAS online. By following the steps outlined here, users can ensure a smooth completion of the claim form.

Follow the steps to successfully complete the form.

1. Press the 'Get Form' button to access the form and open it in the online editor.
2. Complete the Participant Information section by entering your last name, first name, mailing address, and date of birth. Be sure to include your Social Security number or secondary ID number as this information is required. If this is a new address or participant, check the appropriate boxes.
3. In the Dependent Information section, provide the details for each dependent. Enter their name, date of birth, age, and relationship to you. Repeat this for up to three dependents.
4. Specify the period covered by the claims by filling in the 'From' and 'To' dates. Indicate the total amount requested in the designated field.
5. You must include a receipt or have your dependent care provider complete section three. They will need to sign and certify that the provided information is correct.
6. Finally, sign the form in the Participant Signature section, certifying that all information provided is true and correct, and that you are not seeking reimbursement from any other source. Include the date of your signature.
7. Once all sections are completed accurately, you can save your changes, download, print, or share the form as needed.

Get started by filling out your Dependent Care FSA Claim Form online today!