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Fsa mileage worksheet fillable form 2026
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- Click ‘Get Form’ to open the fsa mileage worksheet fillable form in our editor.
- Begin by entering the date of your travel in the 'Date' column. Ensure accuracy as this is crucial for your reimbursement claim.
- In the 'Destination' column, provide the name and address of the medical provider you visited. This information is essential for documentation purposes.
- Next, specify the 'Travel Purpose' for each trip, such as 'Office Visit' or 'Prescription Pick-up'. This helps clarify the reason for your mileage claim.
- Input the total miles traveled in the 'Total Miles' column. Use an online map tool if needed to verify distances.
- Calculate your reimbursement by multiplying total miles by the applicable mileage rate (e.g., $0.24). Enter this amount in the 'Reimbursement' column.
- Finally, sum up all reimbursements to get your 'Total Requested Reimbursement'. Double-check all entries for accuracy before submission.
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