Get Dependentdaycarereimbursement.doc

Completing the Dependent Day Care Reimbursement form can be straightforward if you follow the right steps. This guide will help you navigate the process of filling out the form online, ensuring you provide all necessary information for a successful reimbursement request.

Follow the steps to complete your reimbursement form efficiently.

1. Click ‘Get Form’ button to access the Dependent Day Care Reimbursement form and have it open in your online editor.
2. In the 'Dependent Data' section, enter the period of dependent day care, the name of the dependent, their relationship to you, and their date of birth. Additionally, specify the total cost of care provided.
3. Next, proceed to the 'Provider Data' section. Ensure you attach the signed receipts from the dependent day care provider as specified by the plan rules. Fill in the name of the provider, their Social Security Number or Tax Identification Number, and their street address.
4. Move to the 'Member Data' section. It's important to note that reimbursement eligibility depends on the salary reduction collected in your account. Provide your signature, Social Security Number, and the date of the form completion.
5. After you have filled in all the required sections, review all the information for accuracy. You may then save any changes made, download a copy of the form, or print it for your records.
6. Finally, submit the original form to AmeriFlex as instructed while keeping a copy for your personal records.

Begin the process of submitting your dependent day care reimbursement claims online today.