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HR Employee Forms

Flexible Spending Account Forms:

Form Name Available Formats
(Icon Legend)
Form Descriptions

FSA Claim For Medical And Dependent Care Form

Adobe PDF format file To submit a claim for your flexible spending account.
FSA Direct Deposit For Medical And Dependent Care Form Adobe PDF format file To establish direct deposits of flexible spending account payments.
UA Choice Supplemental Benefit Election Form Adobe PDF format file To add or delete employee selected benefits and/or deductions - i.e., FSA, AD&D, and other employee selected deductions such as accounts payable, parking, United Way, etc.

 

Mt. McKinley photo credit © Rex Melton, Alaska Division of Tourism; flower photo credit Nile Mueller; aurora photo credit Jan Curtis 2003
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