Get Dependent Care Assistance Plan Enrollment Form For The Fy2013 Plan Year (begins July 1, 2012) The

This guide provides clear instructions for users to successfully fill out the dependent care assistance plan enrollment form for the fiscal year 2013. By following these steps, you will ensure that your application is correctly completed and submitted online.

Follow the steps to fill out the dependent care assistance plan enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In the form, enter your last name, first name, and middle initial in the designated fields.
3. Provide your Social Security Number (SSN) in the corresponding space for identification purposes.
4. Fill in the agency name where you are employed.
5. Input your home phone number and work phone number to ensure contactability.
6. Complete your address, including street, city, state, and zip code.
7. Select your benefit choice by marking ‘Initial Enrollment’ if you are a new hire, or ‘Mid-Year Enrollment’ if applicable. Ensure to fill in the 'New Hire Date' if selecting the initial enrollment.
8. If you selected mid-year enrollment, you must provide the applicable change in status code as specified (refer to the change in status code chart).
9. Certify that an eligible change in status event occurred by entering the date of the event.
10. Enter your desired deduction amount per pay period and the number of deductions.
11. Calculate the total annual DCAP amount and ensure it is between the minimum ($240) and the maximum ($4999.92).
12. Carefully read and understand the certification statements included in the form and acknowledge your understanding by signing the document.
13. Finally, make sure to save changes, download, print, or share the form as needed.

Complete your dependent care assistance plan enrollment form online today!