Dependent Care FSA Claim Form - ADP Flexible Spending Accounts 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section 1 with your personal information, including your Social Security Number or Employee ID, company name, and contact details. Ensure you use capital letters and center your text within the boxes.
3. In Section 2, list each dependent care expense separately. For each expense, provide the start and end dates of service, requested amount, provider's tax ID or SSN, and confirm if a receipt is attached. Remember to complete a separate line for each individual expense.
4. Attach supporting documentation by copying receipts onto a white sheet of paper. Write your Social Security Number or employee ID at the top and ensure all receipts face the same direction.
5. Submit your completed form either by faxing it along with the receipts or mailing it to ADP. If you provide an email address, you will receive confirmation of receipt.
6. Opt for Direct Deposit for faster reimbursement processing. Log into your account at myspendingaccount.adp.com to set this up.

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