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D electronically. Print clearly and only in the spaces provided. Step 2 Complete expense information. If the expense was incurred for an eligible dependent, indicate type of relationship in the box on the dependent name line. Use "C" for child, "S" for spouse or "O" for other. Step 3 Sign and date the claim form and attach bills, statements, or other proof of expenses. Your proof of expense must specify the name, tax id (or Social Security Number) of the care provider, date(s) of service, and th.

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