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The tax break you can t afford to ignore review the instructions to submit your claim! Please print or type in all caps. Include your Social Security Number, name, daytime phone, and name of employer. Be sure to sign and date your claim form. Provide the tax ID or SSN and name of the daycare provider. Please complete one line for consecutive dates of care. Incomplete claim forms may result in claim denial or a request for more information. This form allows you to submit up to four (4) e.

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  1. Open the template in our feature-rich online editing tool by clicking Get form.
  2. Fill in the necessary boxes which are marked in yellow.
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  6. Look through the entire document to ensure that you haven?t skipped anything.
  7. Hit Done and download the new form.

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