Spending / Savings Account Forms

PDF  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

PDF  Confirmation Form - Spending-Savings Accounts - Health Savings Account Funding

This form is used to provide confirmation of Health Savings Account (HSA) funding. ID: 5890

PDF  Cost Summary - Spending-Savings Accounts - Flexible Spending Account (500 Plus)

Cost summary for Flexible Spending Accounts (FSA) of 500+. ID: 16120

PDF  Cost Summary - Spending-Savings Accounts - Flexible Spending Account (Fewer than 500)

Cost summary for Flexible Spening Accounts (FSA). ID: 16119