Forms Online FSA Employer

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  • All forms are in Adobe .pdf format.
  • Click on the form you want below. A separate window will open with the selected form displayed.
  • Either print the form or save a copy to your computer.

Employers may save these to your hard drive, then print the form(s) and distribute them to your employees as needed. Employees must submit Enrollment and Change forms to their employer, not to FlexBank.

Standard Enrollment Form Flexible Spending Account Enrollment Form
Direct Deposit Form Direct Deposit Form
Budgeting Worksheet Expense Estimate Worksheet
Change of Status Form Change of Status Form
General Claim Form Flexible Spending Account Claim Form
Dependent Care Claim Form Dependent Care Receipt and Claim Form