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Forms and FAQ

Flexible Spending Account Claim Forms
These forms may be filled in online. You must then print and mail or fax these forms to access your FSA funds. All claims must be submitted with third party documentation (see FAQ links above for details). Fax numbers and addresses are listed on the forms.

Health Care Account Claim Form data enterable form in MS Word format

Health Care Account Claim Form PDF format for those who cannot open MS Word documents. This form must be printed and completed by hand.

Dependent Care Account Claim Form data enterable form in MS Word format

Dependent Care Account Claim Form PDF format for those who cannot open MS Word documents. This form must be printed and completed by hand.

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