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Adp dependent care fsa claim form 2026

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The document provides detailed instructions on how to file a Dependent Child Care Flexible Spending Account (FSA) claim. It outlines the necessary steps, including completing the Claim Form, providing itemized receipts or provider certification, and submitting the documentation to ADP. The document emphasizes the importance of proper documentation as per IRS regulations, explains the difference between incurred and paid expenses, and offers guidance on resubmitting claims if additional information is requested. It also includes tips for ensuring successful claim submission.

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Click ‘Get Form’ to open the ADP Dependent Care FSA Claim Form in the editor.
Complete all Employee Information fields. Enter your name in ALL CAPITAL letters, your employer’s name, mailing address, daytime phone number, and your 10-digit FlexID.
Fill out the Expense Information section. Include one Claim Service Period per line. Ensure that the beginning and ending dates match your receipts, if available.
If you do not have receipts, have your Dependent Care Provider certify the expenses by signing where indicated.
Sign and date your Claim Form. Claims without a signature cannot be processed.
Submit your completed form by faxing it to 866-392-4090 for the fastest processing or mail it to ADP Claims Processing.

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