This document contains both information and form fields. To read information, use the Down Arrow from a form field. Mileage Worksheet SAFES participants can be reimbursed for mileage and parking expenses.
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How to fill out the FSAFEDS Mileage Worksheet online
The FSAFEDS Mileage Worksheet is an essential tool for documenting mileage and parking expenses incurred during travel for medical care. This guide provides comprehensive, step-by-step instructions on how to accurately complete the Mileage Worksheet online for reimbursement purposes.
Follow the steps to accurately complete the Mileage Worksheet
- Click the ‘Get Form’ button to access the FSAFEDS Mileage Worksheet, ensuring you have it open in an editable format.
- Begin by filling in the 'Date' column with the dates of your visits to medical, dental, or vision providers.
- In the 'Provider Name & Address' section, enter the name and address of each healthcare provider you visited.
- Specify the 'Type of Service' for each entry, selecting from medical, dental, vision, or prescription.
- Document the 'Number of Miles Traveled' for each visit. Make sure to accurately calculate and enter the total miles driven.
- For each entry, calculate the total cost by multiplying the number of miles traveled by the applicable mileage rate, and enter this in the 'Total Cost' column.
- If applicable, include any additional 'Parking Cost' associated with your visits in the designated section.
- At the end of the form, sum all costs to determine the 'Total Reimbursement Requested.'
- Before submitting, ensure that you have signed and dated the Certification and Authorization statement, confirming the information is accurate. This is necessary for your form to be considered for reimbursement.
- Finally, save the changes you made to the form, and download, print, or share the completed document as needed.
Start filling out your FSAFEDS Mileage Worksheet online today to ensure your expenses are reimbursed.
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