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Explanation of benefits / Income tax in the United States / Social Security / Itemized deduction / Health / United States / FSA debit card / Government / Medical billing / Taxation in the United States / Employment compensation / Flexible spending account


HEALTH CARE SPENDING ACCOUNT REQUEST FOR REIMBURSEMENT Participant Name: _________________________________________ Please print (First, MI, Last)
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Document Date: 2014-01-23 10:49:08

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File Size: 307,37 KB

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City

Employee / /

Company

Flexible Spending Accounts Funds / /

Currency

USD / /

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Facility

University Benefits Office / University Employee Self Service / University Services Building / University ID / /

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IndustryTerm

overthe-counter products / service/product / insurance plan / insurance / /

Organization

University Benefits Office / Payroll Office / Internal Revenue Service / /

Technology

PDF / /

URL

http /

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