Childcare Subsidy Form: 2019 Re-enrollment

Complete this form if you currently use the childcare subsidy and wish to re-enroll for the 2019 plan year.

Employee's Information

Child(ren)'s Information

Child #1

Is child #1 entering first grade in Aug/Sept 2019?
(First and Last Name of Individual or Name of Organization)

Child #2

Is child #2 entering first grade in Aug/Sept 2019?
(First and Last Name of Individual or Name of Organization)

After completing this form:

  • Log onto BeneTrac (accessible from your myUSF dashboard) to view your subsidy amount during benefits open enrollment (Sept. 17–Oct. 5). The childcare subsidy is added to your Dependent Care Flexible Spending Account (FSA).
  • If desired, contribute your own money up to the annual IRS maximum of $5,000 per household by selecting the appropriate FSA block in BeneTrac during benefits open enrollment.
  • Review and finalize your online benefits enrollment in BeneTrac by Oct. 5. 

If you require assistance with this form or if you are returning to work after experiencing a qualifying event in 2018 (i.e. childbirth or adoption), please email benefits@usfca.edu. If you are expecting a new child in 2019 and do not currently use the subsidy for another child, no action is required at this time. You are eligible to submit a childcare subsidy form for your new child within the first 30 days after your return to work date in 2019. For more information, visit the childcare subsidy web page.