Get Company Name: (required For Processing) Flex Claim Form - Calvin

Completing the COMPANY NAME: (required For Processing) FLEX CLAIM FORM - Calvin is a straightforward process designed to help you submit claims for medical and dependent care expenses. This guide will provide you with detailed instructions to ensure your form is filled out correctly for processing.

Follow the steps to successfully complete your flex claim form.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by entering your company name in the designated field. This is required for processing, so please ensure that it is accurate.
3. Next, provide your Social Security Number, entering at least the last four digits for security purposes.
4. In the Employee Last Name and Employee First Name fields, clearly print your full name.
5. For medical expenses, itemize each expense by documenting the date of service, description of the service, the amount charged, and the provider's name and address. Ensure all supporting documentation is attached.
6. For day care expenses under the dependent care account, have your day care provider either sign the form or provide a receipt for the services rendered.
7. Complete the section detailing the dates of service, the name of the day care provider, and the amount charged for care.
8. Certify your agreement by signing and dating the form, confirming that the information provided is accurate and that you are claiming only eligible expenses.
9. Once you have filled out the form, review all the information for accuracy. You can save changes, download, print, or share the completed form as needed.

Ensure you complete and submit your documents online accurately for timely processing.