FSA Worksheet Tab

Use this tab to enter your estimated out-of-pocket expenses for dependent care.

To use the total amount of your estimates, click Use Estimate. Your total estimate figure is applied to the New Contribution - Annual field of the Medical FSA tab.

The following is a list of common (Out-of-Pocket) dependent care expenses:

• Annual Child Care Expenses
  • Day Care Center
  • In-Home Care and Au Pair Services
  • Nursery and Preschool
  • After School Care
  • Summmer Day Camps
• Annual Elder Care Services
  • Day Care Center
  • In-Home Care

Note: This is not an all-inclusive listing of eligible expenses. Please refer to www.irs.gov for a complete list.