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Print Form Clear Form State of California FlexElect Plan Year 20 FlexElect Reimbursement Claim Form DPA 351 Rev. 09/10 Please read requirements on reverse side Last Name First Name MI Please Print Daytime phone number Street Address Social Security Number City State Zip Dependent Care Reimbursement Account day care babysitting etc. Name of Dependent Age Dates Care Provided From To Name Address and Taxpayer Identification Number of Care Provider C.

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How to fill out the Calhr 351 online

Filling out the Calhr 351 online can streamline your experience when submitting reimbursement claims for dependent care and medical expenses. This guide will walk you through each section of the form with clear instructions to ensure a smooth process.

Follow the steps to successfully complete the Calhr 351 form online.

  1. Use the ‘Get Form’ button to obtain the Calhr 351 form and open it in the editor.
  2. In the employee information section, fill in your name, social security number, mailing address, daytime phone number, city, state, and zip code. Ensure all information is accurate to avoid processing delays.
  3. Proceed to the dependent care reimbursement account section. List your dependent's name and age, along with the name, address, and taxpayer ID of the care provider. Enter the start date and end date of care, and specify the total dependent care amount requested. The care provider must sign and date this section.
  4. Next, fill out the medical reimbursement account section. Include the date the medical care was provided, the name of the medical provider, a description of the medical expense incurred, the person for whom the expense was incurred, their relationship to you, and the amount requested. Note that you must submit detailed statements of services for reimbursement.
  5. Sign the form to certify the accuracy of the information provided and to acknowledge that you understand the responsibilities related to claiming expenses.
  6. Finally, you can save your changes, download a copy of the completed form, print it for your records, or share it as needed. Make sure to keep copies of all documentation for your tax records.

Complete your Calhr 351 form online today for a hassle-free claims process.

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The maximum leave balance for CalHR is determined by various factors that may include your length of service and the specific policies in place. Typically, the leave balance is capped to ensure a fair and consistent use of time off across all employees. Employees using CalHR 351 should keep in mind that exceeding this maximum may result in a loss of accrued leave. For further details or personalized assistance, consider using the US Legal Forms platform, which provides helpful resources and templates to navigate these regulations.

The medically needy pathway in California allows individuals and families with high medical expenses to qualify for Medi-Cal, even if their income exceeds standard limits. It is designed for those who have significant health care needs but do not qualify for traditional Medicaid. To navigate this, you can refer to Calhr 351 for comprehensive details on eligibility and application processes.

The optional FlexElect program in California provides additional benefits for employees to select based on their individual needs. It includes options like health flexible spending accounts that help reduce out-of-pocket expenses. By utilizing resources from Calhr 351, you can maximize the benefits offered through this program.

The California Early Intervention Program is known as Early Start. It supports families with infants and toddlers with developmental delays. You can find valuable information about this service through Calhr 351, ensuring that your family receives the necessary support during crucial early years.

​​​​​​​​​​​​​​​The FlexElect Program allows state employees to set aside money in a reimbursement account to pay for certain kinds of expenses. Deductions occur before tax withholding, reducing your tax liability. Medical Reimbursement Accounts - Set aside money for eligible medical expenses.

The State of California offers employees the FlexElect program with two types of benefits: ✓ Reimbursement accounts for out-of-pocket medical and dependent care expenses. These accounts let you set aside money on a pre-tax basis. This increases your take-home pay and decreases your taxable income.

​​​​If you have qualifying group health and/or dental insurance through a spouse, domestic partner, parent, or another source, you have the option to receive cash in lieu of your state-sponsored health and/or dental benefits.

The FlexElect Program is a voluntary tax savings program available to eligible State of California employees each plan year (January 1 through December 31). The FlexElect Program encompasses two reimbursement options, Medical Reimbursement Account (MRA) and a Dependent Care Reimbursement Account (DCRA).

The FlexElect program for state employees lets you set aside part of your monthly wages in a "Reimbursement Account" to pay for certain expenses which can increase your take home pay and decrease your taxable income.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232