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  • Dependent Daycare Claim Form - Ipmg

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DEPENDENT DAYCARE CLAIM FORM SECTION 125 -REIMBURSEMENT ACCOUNT PLAN HOW TO FILE A CLAIM 1.) Reimbursement can only be made with the submission of one of the following: a. this form completed with.

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Log in to your account at .FSAFEDS.com to file your claim electronically and upload your documentation. Claim processing time: Claims will be processed within 5 business days after receipt of the form. You may check the status of your claim by logging in to your account at .FSAFEDS.com.

You will be reimbursed up to the current amount in your DCFSA at the time your claim is processed. Please note: Payment in advance or a deposit to hold a spot for placement in a program, such as day camp or after-school care, is a reimbursable expense under a DCFSA.

Box 10 on your W-2 form should indicate the total annual amount of your Dependent Care FSA deductions. When completing your tax return, you will need to attach a Child and Dependent Care Expenses form (Form 2441 for a 1040 return; Schedule A for a 1040A return). You should contact a tax preparer for more details.

Place the documents in this order: Dependent Child Care FSA Claim Form first, then the receipt, if available. Please do not return the instruction pages with your claim. Fax to: 866-392-4090 (toll-free) or 678-762-5900. OR Mail to: ADP Claims Processing, P.O. Box 1853, Alpharetta, GA 30023-1853.

Visit your benefits website for a complete list of eligible expenses and documentation requirements. Once you've sent your required items, Smart-Choice Accounts will process your claim within five business days. If we have your email address, we'll notify you when your items have been received.

Ways to Submit a Claim Log into your P&A MyBenefits account and click Upload Claim/Documentation to submit a claim. Mail a claim form to P&A Group at 6400 Main Street, Suite 210 Williamsville, NY 14221 - or fax a claim form to toll-free (877) 855-7105.

Log in to the FSAFEDS app using the same username and password as your online account. Select whether to submit a claim or pay a provider. Follow the prompts to enter claims details. Take photos of your itemized receipts (and other documentation if needed) or upload from your mobile device.

Once your dependent receives the care, you can submit a claim to pay yourself back from your DCFSA. You can do this online, through the PayFlex Mobile® app, or complete a paper claim and fax or mail it to us.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232