01. Edit your dependents eligibility online
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Adp dependent care fsa claim form 2026
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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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See more dependents eligibility versions
We've got more versions of the dependents eligibility form. Select the right dependents eligibility version from the list and start editing it straight away!
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2011 | 4.7 Satisfied (27 Votes) |
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