If you pay out-of-pocket for DCFSA or Commuter pre-tax expenses and don’t have an itemized receipt, you can include a completed reimbursement form when you file a claim from your Forma account. Forma cannot accept self-made receipts.
Use these manual reimbursement forms for expenses paid out of pocket when the receipt does not include the required information. These forms cannot be used to substantiate card transactions.
Attach the form along with your other supporting documentation such as an emailed invoice, bank statement, or other proof of payment when filing your claim.
Please note that only completed services can be reimbursed. Please list service start and end dates on the form so that Forma’s claim review team can better verify eligibility.