MCC Daily Tribune Archive

New Expense Receipt Form for Dependent Care Flexible Spending Claims

EBS-RMSCO has developed a new Dependent Care expense receipt form.  This new form will help to simplify processing of Dependent Care Claims and will also act as a receipt and a claim form all in one.
Below is the process for completing this new form.

The day care provider will need to complete the receipt portion of the form.  This will eliminate participants having to provide a separate receipt and a claim form. The provider’s signature will confirm proof of payment.

The dates of care should be equal to the time period that the care was provided.  If there is no provider signature the claim will be returned.  As a reminder, Dependent Care expenses will not be reimbursed prior to the end date in the receipt section on the form.  IRS regulations specifically state that Dependent Care expenses cannot be paid prior to the date incurred.

This form is now available on the EBS website at, under the Document Library tab.   We are also attaching a copy of this form for your convenience.

If you have any questions regarding this new form please contact Karen Rheinheimer in the HR Office at extension 2113.  Thank you.

Karen Rheinheimer
Human Resources

icon ReimbForm_DCAP_2010_Buf.pdf