Get Flexible Spending Account Claim Form - Fgcu

This guide provides step-by-step instructions for completing the Flexible Spending Account Claim Form - Fgcu online. Whether you are a first-time user or have experience with the form, these clear directions will help ensure you accurately fill it out and submit it.

Follow the steps to complete your claim form successfully.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling out the personal data section at the top of the form. Provide your full name, home phone number, street address, city, state, zip code, social security number, employer, daytime phone number, and email address. Ensure all fields are completed accurately using black ink.
3. Review the certification statement carefully. By signing the claim form, you acknowledge the conditions specified, including the use of FSA for IRS-qualified expenses only.
4. In the medical reimbursement account section, indicate if you used the myMRA card or if you are submitting out-of-pocket expenses. Attach the required documentation for your expenses.
5. Fill in the service date, name of the person who received the service, their relationship to you, and the provider of services. Specify the claim amount for each service incurred.
6. In the dependent care reimbursement account section, enter comprehensive details including the name and relationship of the person receiving services, their age or grade, and the name and address of the care provider for qualifying services.
7. Ensure all forms and documentations are attached as specified, and make sure to keep a copy of the claim form for your records.
8. Finally, review all entered information for accuracy before saving your changes. You may download, print, or share the form based on your needs.

Complete your claim form online today to ensure timely reimbursement for your eligible expenses.