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Dependent Care Reimbursement Account Claim Form

Please use this form to request reimbursement for dependent day care expenses.

Questions about a claim? Please contact HealthEquity at 877-924-3967.

Form NameFormat
Dependent Care Reimbursement Account Claim Form
(can be filled in electronically)
PDF

Categories

Benefits - Dependent Care Reimbursement Account, Benefits - Reimbursement Accounts