Management Benefits Fund (Mbf) Health And Fitness Reimbursement Program Claim Form Page 2

Download a blank fillable Management Benefits Fund (Mbf) Health And Fitness Reimbursement Program Claim Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Management Benefits Fund (Mbf) Health And Fitness Reimbursement Program Claim Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

- CLAIM FILING GUIDELINES -
1. The MBF member and/or spouse/domestic partner and the facility manager from your fitness facility must complete this
form.
2. You are eligible for reimbursement after completing six consecutive months of regular exercise at an MBF approved
health club.
3. After each six-month period, you will be reimbursed up to a maximum of $250.00. This benefit will be included in taxable
income to the MBF member in the year in which it is received. Claim forms are available through the MBF web site at
nyc.gov/mbf or by calling (212) 306-7290. Outside NYC call toll-free at (888) 4000-MBF (623). Please mail completed
claim form to: Management Benefits Fund, Bowling Green Station, P.O. Box 707, New York, NY 10274
4. You must complete a separate claim form for each consecutive six-month exercise period and attach a copy of the pay-
ment receipt. Please note that only the MBF member and MBF member’s spouse/domestic partner are eligible for this
benefit. Other dependents are not eligible for this benefit.
5. MBF reserves the right to request additional documentation and/or deny any claims.

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Qualified Parking And Transportation Reimbursement Program Request Form - Benefit Advantage Qualified Parking And Transportation Reimbursement Program Request Form - Benefit Advantage Business
Form Rpd-41326 - Rural Health Care Practitioner Tax Credit Claim Form Form Rpd-41326 - Rural Health Care Practitioner Tax Credit Claim Form Financial
Form Rpd-41326 - Rural Health Care Practitioner Tax Credit Claim Form Form Rpd-41326 - Rural Health Care Practitioner Tax Credit Claim Form Financial
Health Care Flexible Spending Account (hcfsa) Program Claim Form Health Care Flexible Spending Account (hcfsa) Program Claim Form Legal
Health And Fitness Assessment Questionnaire (vitality) Health And Fitness Assessment Questionnaire (vitality) Business
Form 150-211-158 - Workers' Benefit Fund Assessment Corrections And Changes Notification Sheet - 2013 Form 150-211-158 - Workers' Benefit Fund Assessment Corrections And Changes Notification Sheet - 2013 Legal
Health And Fitness Expo Invitation Template Health And Fitness Expo Invitation Template Life
Health And Fitness Goal Assessment - Questionnaire Health And Fitness Goal Assessment - Questionnaire Medical
Form Rpd-41326 - Rural Health Care Practitioner Tax Credit Claim Form - State Of New Mexico Taxation And Revenue Department Form Rpd-41326 - Rural Health Care Practitioner Tax Credit Claim Form - State Of New Mexico Taxation And Revenue Department Financial
Form Rpd-41326 - Rural Health Care Practitioner Tax Credit Claim Form - State Of New Mexico Taxation And Revenue Department Form Rpd-41326 - Rural Health Care Practitioner Tax Credit Claim Form - State Of New Mexico Taxation And Revenue Department Financial

Related Categories

Parent category: Legal
Download
Go
Page of 2