Get 2014 Fsa Request Form - Group Dynamic

Filling out the 2014 Flexible Spending Account (FSA) Request Form - Group Dynamic can seem daunting, but with clear instructions, you can navigate it with ease. This guide provides a step-by-step approach to ensure you complete your submission correctly and efficiently.

Follow the steps to fill out the FSA request form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing the employee information section. This includes entering your name, social security number, employer's name, and plan year.
3. Move to the dependent care section. Enter the provider's name, social security number or tax ID number, the name of the person receiving the care, their relationship to you or their age, dates of service, and the total amount requested.
4. If you do not have a receipt for dependent care, fill out the provider's details including their address and sign the certification statement to confirm the service was provided.
5. Proceed to the medical care section. Include the provider's name, descriptions of services purchased, and any applicable dates and amounts. If you are claiming mileage, provide the number of miles traveled for eligible medical appointments.
6. Double-check that all information listed is accurate. Add your signature and date at the bottom of the form, confirming that the expenses have not been reimbursed elsewhere.
7. Attach any necessary receipts that verify the date of service, provider information, type of service, and amounts. Ensure you have copied these documents for your own records, as submitted materials will not be returned.
8. Finally, save the completed form, and choose to download, print, or share it as necessary. Submit your request before 12 noon (ET) on Tuesdays for processing that week.

Complete your documentation online today for a smooth reimbursement process.