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  • Ca Dpa 351 2010

Get Ca Dpa 351 2010-2025

Print Form Clear Form State of California FlexElect Plan Year 20 FlexElect Reimbursement Claim Form DPA 351 Rev. 09/10 Please read requirements on reverse side Last Name First Name MI Please Print Daytime phone number Street Address Social Security Number City State Zip Dependent Care Reimbursement Account day care babysitting etc. Name of Dependent Age Dates Care Provided From To Name Address and Taxpayer Identification Number of Care Provider C.

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How to fill out the CA DPA 351 online

This guide provides a step-by-step process for completing the CA DPA 351 form online. Designed to be clear and supportive, this guide caters to users of all experience levels.

Follow the steps to successfully complete the CA DPA 351 form.

  1. Click the ‘Get Form’ button to access the CA DPA 351 form and open it for editing.
  2. Fill out the Employee Information section, including your name, Social Security Number, mailing address, and daytime phone number. Make sure all information is accurate and current.
  3. In the Dependent Care Reimbursement Account section, provide details about your dependent. This includes their name, age, the care provider's information, and the dates care was received. Remember, only claim expenses for dependents under the age of 13 or those unable to care for themselves.
  4. Complete the Medical Reimbursement Account section. List the date medical care was provided, the name of the medical provider, a description of the medical expense, and the relationship of the person for whom the expense was incurred.
  5. Make sure to attach a detailed statement of services or an insurance explanation of benefits for each medical expense claimed, as credit card receipts are insufficient.
  6. Review all entries and ensure your signature and date of signing are written at the bottom of the form, confirming the accuracy of the information provided.
  7. Finally, save your changes, and choose whether to download, print, or submit the form online.

Take the next step and complete your CA DPA 351 form online today!

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​​​​​​​​​​​​​​​The FlexElect Program allows state employees to set aside money in a reimbursement account to pay for certain kinds of expenses. Deductions occur before tax withholding, reducing your tax liability. Medical Reimbursement Accounts - Set aside money for eligible medical expenses.

​​​​​​​​​​​​​​​The FlexElect Program allows state employees to set aside money in a reimbursement account to pay for certain kinds of expenses. Deductions occur before tax withholding, reducing your tax liability. Medical Reimbursement Accounts - Set aside money for eligible medical expenses.

The FlexElect Program is a voluntary tax savings program available to eligible State of California employees each plan year (January 1 through December 31). The FlexElect Program encompasses two reimbursement options, Medical Reimbursement Account (MRA) and a Dependent Care Reimbursement Account (DCRA).

The State of California offers employees the FlexElect program with two types of benefits: ✓ Reimbursement accounts for out-of-pocket medical and dependent care expenses. These accounts let you set aside money on a pre-tax basis. This increases your take-home pay and decreases your taxable income.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232