Many of your Customers need an FSA (Flexible Spending Account) or Dependent Care report so they can be reimbursed by their plan. Most FSA/Dependent Care reports require the following information:
Provider name (your company name), address, and Tax ID
Participant name (Account Holder/Parent)
Dependent's name(s) (Enrollee/Child)
Service dates of care provided
Type of service
Total amount of fees per dependent/enrollee
Signature of director/Admin
There are two ways to produce a report with most or all of this information:
Add dates of service to invoicing, then print a transaction statement
Create a Dependent Care form and send it out for e-signature
Method 1 — Add Dates of Service and Print a Transaction Statement
This is the most commonly used method. It involves adding dates of service to your invoices so they appear on transaction statements.
NOTE: If you add dates of service in invoicing after enrollment, they won't appear on invoices that have already been processed. In that case, add the dates of service manually as a comment on those invoices — see Add Comments To A Transaction below.
Step 1 — Add Dates of Service to Invoicing
Add dates of service to your invoicing for each Payment Plan/Payment Event within each Enrollment Period. See How to Add Dates of Service Comment on Invoices for detailed steps.
Once added, the dates of service comment appears in the Customer's transaction history like this:
Step 2 — Print a Transaction Statement
Print a transaction statement from the Customer's Billing page:
Click the print icon at the top right of the Transaction History
Click Print Statement
Select the date range you need, then click Load
Click Print, or save the statement as a PDF to email to the Customer
Add Comments to a Transaction
If you added dates of service after a transaction was already posted, add them as a comment on that transaction instead. Comments can be:
Public — visible to the Customer in the Customer Portal
Private — visible only to Admin Users
There are three ways to add a comment:
Add current invoice — On the Customer's Billing page, under their Payment Plan, click + Add current invoice, then add a public or private comment with the dates of service
Edit an existing transaction — Add or edit a comment on a transaction that's already posted. Do this either from the Invoices page (click Details next to the invoice, click the three dots on the line item, then Edit) or from the Customer's Billing page (click the three dots on the line item in the Transaction History)
Transactions window — Click Transactions in the left-hand menu to open a window where you can enter a charge, payment, refund, or credit, and add a public or private comment with the dates of service
Method 2 — Create a Dependent Care Form for E-signature
The second way to create an FSA/Dependent Care receipt is with the e-signature feature. You can download a template and customize it as your own Dependent Care receipt form.
NOTE: E-signatures cost $2.50 per signature request. A signature request is created when a document is sent out for signature, whether it comes back fully or only partially signed — either way, it counts as one request.
Use this template to get started: Dependent Care Receipt. It looks like the example below, which you can edit to make your own.
Step 1 — Map Field IDs
If you're sending the form to the Account Holder (parent/guardian), you can map in fields from the Enroll Form automatically. On the left, you'll see the fields from the Enroll Form Editor; on the right, you'll see how they'll appear in the Designer, where you place fields on the document.
If you want the exact wording shown on the left, click Fill and it will be added to the right (a checkmark will appear). Once the fields look the way you want, click Next.
Step 2 — Set Up The Document
Under Setup, click Upload Document to upload the document from your computer, then fill in the following:
Title — Enter a title (you can change this later)
Required At — Choose whether this document is required at the Primary Account Holder, Enrollee, or Enrollment level
Expiration — Leave this blank
Redirect URL — Optionally add a URL to send signers to once they finish signing. By default, they're sent to the Customer App home page
Signers — Choose whether you need a parent's signature. If so, leave the signer type at Primary Account Holder/Parent. For a provider (Admin User) signature instead, use Typed Email and enter the email address the document should go to
Step 3 — Design The Document
Use the pink Sender fields for anything you want mapped in automatically. Use the blue Signer fields for anything the signer (for example, the provider) needs to fill out themselves. See How to Design an E-signature Document for more on designing a document.
Step 4 — Send A Test
Search for any existing account by Enrollee or Account Holder name that has enough information filled in to test with — any active account works, and the document will not be sent to the real Account Holder/Signer
Enter the email address where you want to receive the test document (this can be your own)
Click Send Test
Check that inbox for an email with the subject line "[Company Name] [Document Name] - Signature requested by Enrollsy.com," sent from noreply@mail.hellosign.com.
Click Review & Sign
Click OK, then Get Started to go through the document as a Customer would
