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Optum Financial Dependent Care Form. With a dependent care fsa, you choose how much to contribute, up to a maximum of $5,000 per household, per year. How to file a claim.
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Your employer deducts this amount from each paycheck, before taxes. How to file a claim. In addition, you must send in a new recurring dependent care reimbursement request form for each new plan year. Visit us online at optumbank.com or call the number on the back of your debit card if you have any questions while completing. Web what is a dependent care fsa? Web dependent day care account claim and provider documentation form use this form to submit your claims for reimbursement of eligible dependent day care expenses. Learn about the different types of fsas and how they help you save. Your account is funded by payroll deductions before taxes. In addition, you must send in a new recurring dependent care reimbursement request form for each new plan year. Web please complete this form to establish a recurring dependent care reimbursement request. Web browse this helpful information to better understand your dependent care fsa.
