Dependent Care Verification Form - Dependent care account claim and provider documentation form. Use this form to submit your claims for reimbursement of eligible dependent. Verification of dependent care expenses. This form is used for certification of the dependent care provider's name, address, and taxpayer identification number to report on. Dependent care account claim and provider documentation form. Use this form to submit your claims for reimbursement of eligible. Attach this form to an online or debit card claim via your online account or to a claim form.
Use this form to submit your claims for reimbursement of eligible. Attach this form to an online or debit card claim via your online account or to a claim form. Dependent care account claim and provider documentation form. This form is used for certification of the dependent care provider's name, address, and taxpayer identification number to report on. Verification of dependent care expenses. Dependent care account claim and provider documentation form. Use this form to submit your claims for reimbursement of eligible dependent.