Get 18666432219

This guide provides a clear, step-by-step approach to completing the 18666432219 form online for submitting dependent care flexible spending account claims. Proper completion of this form is essential for ensuring timely reimbursement.

Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the digital version of the form and open it in your editor.
2. In Section 1, ensure your employee information is accurate. Verify that the pre-populated details, including your name, employer's name, address, telephone number, and participant ID are correct. If any updates are needed, contact your employer or HR representative.
3. Proceed to Section 2 to enter your expense information. Fill in the start date and end date of the dependent care service in MMDDYY format, followed by the dependent's name and the provider's name from whom the service was received. List the amounts for each service in dollars and cents.
4. Calculate the total expenses at the bottom of Section 2, ensuring that all amounts accurately reflect the services rendered.
5. If you are resubmitting a claim, enter the reference ID in the designated optional field.
6. Complete Section 3 if you do not have receipts. This requires the service provider's signature and date to certify the services incurred. This section is mandatory only if receipts are unavailable.
7. In Section 4, provide your signature and the date, certifying that the expenses qualify for reimbursement under IRS regulations and confirming that these expenses have not been claimed elsewhere.
8. Once all information is filled correctly, review the form for any errors. You may then save the changes, download, print, or share the completed form as needed.

Complete your dependent care claims online for a fast and secure process.