Fsa mileage worksheet fillable form 2026

1. Click ‘Get Form’ to open the fsa mileage worksheet fillable form in our editor.
2. Begin by entering the date of your travel in the 'Date' column. Ensure accuracy as this is crucial for your reimbursement claim.
3. In the 'Destination' column, provide the name and address of the medical provider you visited. This information is essential for documentation purposes.
4. 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.
5. Input the total miles traveled in the 'Total Miles' column. Use an online map tool if needed to verify distances.
6. Calculate your reimbursement by multiplying total miles by the applicable mileage rate (e.g., $0.24). Enter this amount in the 'Reimbursement' column.
7. Finally, sum up all reimbursements to get your 'Total Requested Reimbursement'. Double-check all entries for accuracy before submission.

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