Get Dependent Care Reimbursement Request - Choice Strategies

Filling out the Dependent Care Reimbursement Request form can seem challenging, but with the right guidance, you can complete it easily and accurately. This guide offers detailed instructions to help you navigate each section of the form online.

Follow the steps to complete your reimbursement request effectively.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Enter your employer name in the designated field. This is necessary for verifying your employment details.
3. Fill in your employee social security number to help process your reimbursement efficiently.
4. Input your employee last name and first name along with your middle initial, if applicable. This ensures your identity is clear.
5. Provide the account type related to your claim from options such as HRA, FSA, DCA, PKG, TRN, or PRA.
6. Specify the date of service for which you are requesting reimbursement.
7. Indicate the amount of reimbursement you are requesting.
8. Select whether you would like to be reimbursed directly or if you want the payment to go to your provider.
9. If you chose to pay your provider, fill in the provider's name and account number. If applicable, provide their address, city, state, and zip code.
10. Repeat steps 5 to 9 for any additional claims. Ensure all information is accurate and complete.
11. Sign the form and date it to confirm the accuracy of the information provided.
12. Send your completed claim form as instructed to claims@choice-strategies.com or fax it to 1-888-415-6471.

Complete your Dependent Care Reimbursement Request online today!