Get Humphrey And Pace Fsa Form

This guide outlines the process of completing the Humphrey And Pace Fsa Form online, ensuring that all necessary information is accurately provided. Users will find detailed step-by-step instructions tailored to their needs, facilitating a smooth filing experience.

Follow the steps to successfully complete your Humphrey And Pace Fsa Form online.

1. Press the ‘Get Form’ button to retrieve the Humphrey And Pace Fsa Form and open it in your preferred editor.
2. Begin by filling out your personal information. This includes your employer, daytime phone number, your full name, the last four digits of your Social Security number, and your mailing address, including the city, state, and zip code.
3. Indicate if a person other than yourself will pick up the check by listing their name. Remember that this requires ID for verification.
4. Report any address changes in the appropriate section. If you fail to notify about an address change and a check goes missing, you will incur a $15.00 fee.
5. Provide details for your expenses in the designated sections. List the amounts under 'Health FSA Expenses' and 'Dependent Day Care Expenses’. Ensure that you include the service dates and a brief description of the services provided.
6. Calculate the total reimbursement amount requested and write it in the designated area.
7. Review and confirm that the information provided is complete and true. This is found in the Employee Authorization section where you will also need to sign and date the form.
8. Once all sections have been filled out accurately, save the changes. You can then download, print, or share the completed form as needed.

Complete your Humphrey And Pace Fsa Form online today to ensure timely reimbursement.