Get Please Keep The Yellow Copy For Your Records

Filling out the Please Keep The Yellow Copy For Your Records form online can be a straightforward process with the right guidance. This guide offers step-by-step instructions to help users effectively complete the necessary sections.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access the form and open it in your online editor. This ensures that you have the correct document to complete.
2. Begin with Section I: Personal Information. Enter your employer's name, your name, and your Social Security number. Additionally, provide your mailing address, work phone number, and home phone number to ensure all contact details are accurate.
3. In Section II: Dependent Daycare Expense Claims, list the period covered for daycare, followed by the name(s) of your dependent(s). Fill in the name, address, and taxpayer identification number of the service provider, along with the total amount incurred for the services.
4. Proceed to Section III: Unreimbursed Medical Expense Claims. Document the date and service provided, the name of the service provider, the description of the service, and the person for whom the expense was incurred. Ensure to attach documentation that shows all required information and the total medical care expenses.
5. In Section IV: Other Claims, indicate the date of service and the person for whom coverage was provided. Fill in the name of the service provider and a description of the expenses incurred, along with the net amounts after all insurance payments.
6. Finally, complete Section V: Certification. Sign and date the form, affirming that all submitted claims are accurate and have not been reimbursed elsewhere.
7. Once you’re finished, review the entire form for accuracy. You can then save your changes, download the document, print it, or share it as needed.

Start filling out your claim for reimbursement online today for a smooth and convenient experience.