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1350 S. Boulder Avenue |
Reimbursement Claim Forms How to file a claim: When filing your claim for reimbursement, you must attach copies of the receipts. (Keep your original receipts for your records.) The receipt must show the date and type of service for the expense. Canceled checks, credit card slips, or statements showing only a balance due on your account are not allowable. Click here for an Unreimbursed Medical and Dependent/Child Care reimbursement claim form [PDF]. Click here for a Qualified Transportation reimbursement claim form [PDF]. Click here for a Health Reimbursement Arrangement (HRA) reimbursement claim form [DOC]. Mail or fax your claim to the address/fax at left.
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