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Get Recurring Dependent Care Request Form - Southwest Healthcare ...
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How to fill out the Recurring Dependent Care Request Form - Southwest Healthcare online
This guide provides step-by-step instructions for completing the Recurring Dependent Care Request Form for Southwest Healthcare online. It is designed to simplify the process and ensure you accurately submit your request for dependent care reimbursements.
Follow the steps to successfully complete your request form.
- Press the ‘Get Form’ button to access the Recurring Dependent Care Request Form online.
- Fill in the participant information, including your name, social security number, employer name, and employee ID. Ensure all required fields are completed legibly to avoid processing delays.
- Select the appropriate option for the Recurring Dependent Care Account (DCA) information: starting a new reimbursement, changing current information, or stopping reimbursement. Be sure to provide an effective date for any changes.
- Provide dependent care provider information, including the names of your dependents, start and end dates of service, the provider's signature, and the weekly cost of care. This section must be completed by your dependent care provider.
- Review the participant certification carefully. By submitting the form, you acknowledge that the information is complete and accurate, that the services are eligible expenses, and that you will not seek reimbursement from other sources.
- Once all information is completed, save your changes and choose to download, print, or share the form as needed for submission.
Begin completing your Recurring Dependent Care Request Form online now.
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.
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