Flexible Spending – Dependent Care – Human Resources

Dependent care expenses

The current dependent care limit for dependent care is $5,000 annually per household.

You may claim your eligible expenses by submitting a reimbursement claim form along with copies of your expense receipts.

You may roll over up to $500 of unused FSA funds at the end of the plan year.

Name * Required
Telephone Number * Required
Email Address * Required
Name of Financial Institution * Required
Financial Institution's Telephone Number * Required
Routing Number (nine digits) * Required
Account Number * Required
Type of Account * Required
- Checking
- Savings
Acknowledgement * Required
I wish to be reimbursed via direct deposit for eligible flexible spending expenses. I hereby authorize Kalamazoo College to share my banking information with Burnham & Flower Group. I recognize that if I fail to provide complete and accurate information on this authorization form, the processing of the form may be delayed or my payments may be erroneously transferred electronically. I further understand that this information stays in effect until I submit a change or cancellation request. I consent to and agree to comply with the National Automated Clearing House Association Rules and Regulations that exist on the date of my agreement on this form or as subsequently adopted, or amended, or repealed.
Consent * Required
I have read the above important message and agree to the terms and conditions of Flex Spending direct deposit.