Get Spending Account Reimbursement

This guide provides clear, step-by-step instructions on how to accurately fill out the Spending Account Reimbursement form online. By following these directions, users can ensure their claims are processed efficiently and correctly.

Follow the steps to complete your form effectively.

1. Click ‘Get Form’ button to access the Spending Account Reimbursement form and open it in your preferred editor.
2. Begin filling out the form by entering the required fields. Start with the employer section; provide your employer's name as requested.
3. Enter your name in the Participant Name field, followed by your daytime phone number for contact purposes.
4. Fill in your Social Security number and, if applicable, your mailing address only if it has changed. Also, include your email address to receive confirmation after your claim is processed.
5. For Medical, Dental, or Vision Care expenses, indicate the dates of service. Fill in the 'Date From' and 'Date To' fields and record the total amount for reimbursement.
6. For Dependent Care expenses, repeat the same process: enter the service dates and the total amount. Keep in mind that IRS regulations dictate these expenses must be for custodial care.
7. If you are submitting multiple expenses, ensure to list the earliest and latest dates of service and the total amount for all claims in one submission.
8. Attach valid documentation for all the expenses claimed, making sure it contains dates of service, amounts, types of service, and provider information as required by IRS regulations.
9. Complete the fields for the dependent care provider's name, tax ID, and address if they are not included in the submitted documentation.
10. In the comments section, provide any pertinent information regarding your claim or expenses.
11. Review the certification statement and sign, adding the date to confirm your claim statement is accurate.
12. Once all required sections are filled out, you may save the changes you have made, download a copy for your records, print it if necessary, or share it with the appropriate parties.

Complete your Spending Account Reimbursement form online today for efficient processing of your claims.