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Recurring Dependent Care Request Form Completion Guide Step 1: Participant Information Complete the required fields (*). Changes to your profile can be made by logging in to your account at www.discoverybenefits.com. Please.

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This form is to be completed each plan year and as changes occur when the accountholder wants to receive recurring reimbursement of dependent care expenses. Reimbursements will not be made prior to when the dependent care services are provided.

Dependent Care Benefits (reported on a W-2 form) is an option employers can provide for their employees for the purpose of withholding pre-taxed money from each paycheck to help pay for the care of a child, spouse, or other dependent adult who lives in their household.

You're receiving a tax benefit because under the plan, you're not paying taxes on the money set aside to pay for the dependent care expenses. You must complete and attach Form 2441, Child and Dependent Care Expenses to your tax return.

You may enroll in the plan during your employer's open enrollment period prior to the start of the plan year. You may also enroll mid-year if you are a newly hired employee, or if you have a qualified Status Change Event as outlined in the Summary Plan Description.

A dependent care FSA is better for employees who can access it because these pre-tax deductions can substantially reduce the employee's income, social security and medicare taxes. Plus, it saves even more if your state imposes income tax and other types of taxes.

For a dependent care expense to be eligible for reimbursement from a Dependent Care FSA, the care must be to enable you and your spouse to work, actively look for work, or attend school full-time.

The main benefit of an FSA is that the money set aside in the account is in pretax dollars, thus reducing the amount of our income subject to taxes. For someone in the 24% federal tax bracket, this income reduction means saving $240 in federal taxes for every $1,000 spent on dependent care with an FSA.

Required Documentation: Itemized statement from the provider with a clear description of service provided, name of the patient, date of service, the amount paid for service, and name of the provider. A signed statement indicating there is no insurance coverage for the service provided.

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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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