Instructions completing the eap case activity and billing form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Employee (Participant) Information section. Clearly type or print your last name, first name, middle initial, home address, social security number, and contact numbers. Ensure accuracy as this information is crucial for processing.
3. In the DeCAP Reimbursement Requests section, list each dependent's name and provide all dates of service. Make sure these dates are prior to when you sign the form. Specify the type of service provided and enter the reimbursement amount requested.
4. For each service listed, include the provider’s name and address along with their federal tax ID or social security number. This information is mandatory for reimbursement processing.
5. Finally, sign and date the form in the Employee (Participant) Signature section to confirm that all information is accurate and complies with DeCAP rules.

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