Completing the 125-FSA Claim Form
{"Image DocumentName": "Completing the 125-FSA Claim Form", "Image ImageDescription": "Make sure to complete and sign the top section of the 125-FSA Claim Form by printing your full name,  address (if you have one), name of your employer and your participant ID number (assigned by DBS, Inc.) or Social Security number. In addition, complete Dependent Care Reimbursement Account box for your dependent care expenses and/or the Medical Reimbursement Account box for your medical, dental, and vision type expenses. Claim forms may be mailed or faxed to DBS, Inc. The address and fax number are shown on the form. The next slide illustrates how to complete the claim form. Retain this slide if check is sent to employee and Direct Deposit is not an option. How to File a Claim.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}