Get Dependent Care FSA Claim Form - ADP Flexible Spending Accounts

Bottom line: You can reimburse yourself from an HSA or FSA. However, you need to make sure you keep track of your medical expenses and ensure they're all qualified before you reimburse yourself to avoid penalties and taxes.

Your Dependent Care FSA is intended to help you pay for eligible dependent care expenses to allow you to work. Therefore, you cannot be reimbursed for expenses incurred while you are on a leave of absence from work.

You use your FSA by submitting a claim to the FSA (through your employer) with proof of the medical expense and a statement that it has not been covered by your plan. You will then receive reimbursement for your costs. Ask your employer about how to use your specific FSA.

Pay yourself back during the year Get some financial relief with a dependent care FSA. Contribute up to $5,000 pretax for the plan year. After your dependents receive care, you can submit claims to pay yourself back. Just be sure to use all your funds during the plan year.

While you cannot receive both tax benefits for the same expenses, you may be able to claim both tax benefits if your expenses exceed $5,000. If you have two or more children, you could set aside the first $5,000 pre-tax into an FSA and claim up to $1,000 of remaining expenses for the dependent child-care credit.

How do I submit a receipt for reimbursement under my Healthcare or Dependent Care FSA? There are two ways to submit a receipt for reimbursement: Through the WageWorks EZ Receipts® mobile app. Use your mobile device to snap a photo of your receipts and submit them for reimbursement.

Once you have paid for expenses that qualify for reimbursement from the FSA you will need to complete a claim form provided by your employer and attach receipts or proof of payment with the form. The receipts must include specific information to prove that the payment was for qualified expenses.

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.

Once you have paid for expenses that qualify for reimbursement from the FSA you will need to complete a claim form provided by your employer and attach receipts or proof of payment with the form. The receipts must include specific information to prove that the payment was for qualified expenses.

Your child must be under the age of 13 for you to use a Dependent Care FSA for their care expenses. These expenses need to be work-related meaning you and your spouse must be working, looking for work, or attending school full-time. You'll pay your dependent care costs directly and then apply for reimbursement.