Get Claim Formrev09092009.doc

Filling out the Claim FormRev09092009.doc accurately is essential for ensuring a smooth reimbursement process. This guide will provide clear, step-by-step instructions to help you complete the form online with confidence.

Follow the steps to complete your claim form online

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Enter your employee name in the designated field at the top of the form. This information is critical for identifying your claim.
3. Provide your social security number in the next field. Ensure accuracy as this number is used for verification.
4. Fill out your home address completely, including city, state, and ZIP code. Check the box if this is a new address.
5. Input your employee number, date of birth, and home phone number as required in the appropriate fields.
6. Attach valid receipts for each dependent care expense directly to this form. Keep in mind that receipts are necessary for processing your claim.
7. Indicate the dates of service for the care provided in the sections labeled 'FROM' and 'TO.' This information helps validate your claim.
8. For each dependent, list their name, relationship to you, and date of birth in the relevant fields.
9. Fill in the name and address of the DCAP provider, along with the provider's Tax ID or Social Security Number.
10. Enter the claim amount for each dependent care expense. Summarize the total amount claimed in the designated field at the bottom of the section.
11. Review the certification statement before signing. Ensure all information submitted is accurate and that expenses claimed are eligible.
12. Sign and date the form before submission. This signature is crucial for processing your claim.
13. After filling out the form, save your changes. You may choose to download, print, or share the completed form as needed.

Complete your Claim FormRev09092009.doc online today to ensure timely reimbursement.