Spending / Savings Account Forms
Application - Spending-Savings Accounts - Flexible Spending Account
Employers & Brokers use this form to apply to establish a cafeteria plan under Section 125 of the Internal Revenue Code. ID: 8316
Confirmation Form - Spending-Savings Accounts - Health Savings Account Funding
This form is used to provide confirmation of Health Savings Account (HSA) funding. ID: 5890
Cost Summary - Spending-Savings Accounts - Flexible Spending Account (500 Plus)
Cost summary for Flexible Spending Accounts (FSA) of 500+. ID: 16120
Cost Summary - Spending-Savings Accounts - Flexible Spending Account (Fewer than 500)
Cost summary for Flexible Spening Accounts (FSA). ID: 16119
