Get Zbxdkpv

This guide provides clear instructions on how to complete the Zbxdkpv form for requesting reimbursement from your dependent care account. By following these steps, you will be able to efficiently prepare and submit your claim for eligible expenses.

Follow the steps to successfully complete the Zbxdkpv form.

1. Click ‘Get Form’ button to access the Zbxdkpv form and open it in the designated form editor.
2. Provide your employee information in Section 1. Enter your employee user ID, last name, first name, daytime phone number, and email address. Be sure to use capital letters and complete all required fields.
3. In Section 2, complete a separate line for each dependent care expense. Enter the start date of service, provider's tax ID or Social Security number, requested amount, end date of service, dependent's date of birth, and dependent's name. Ensure to fill in all ovals as shown.
4. Attach supporting documentation for each expense. Include a bill or signed receipt. If the receipt is unavailable, have the provider sign the affidavit in Section 2.
5. Read the Certification in Section 3 carefully. After reviewing, sign and date the form where indicated.
6. Submit your form by fax to the provided toll-free number or by mail to the FSAFEDS Program address. Ensure that supporting documentation is included with your submission.
7. Keep a copy of your completed form and all receipts for your records. Ensure you are aware of the minimum reimbursement threshold of $25.00.

Start filling out your Zbxdkpv form online today to ensure timely reimbursement for your dependent care expenses.