Useful Forms and Documents
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Submit this form in order to request reimbursement for your out-of-pocket expenses. Please note that you will need to include a detailed service statement (NOT JUST PROOF OF PAYMENT) in order for your reimbursement request to be approved. |
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Complete this form to establish a payroll deduction for your FSA or DCAP. This form will only be accepted during the annual open enrollment period, or if you are a new hire. |
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If you would like to request the FSA debit card, please complete and submit this form. |
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If you have experienced a qualifying event and would like to modify your FSA/DCAP election amount as a result of this, please complete this form. |
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If you would like to expedite your reimbursement and notification process from ASIFlex, please complete this form. This information will be maintained in ASIFlex's system for as long as you are enrolled in the programs. |
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If you would like to sign up for email notification for all account activity, please complete this form. |
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If you would like to have another individual be able to call ASIFlex and access detailed information about your account, please complete this form. |
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Certain medical expenses require that this form be completed by your medical provider in order for them to be eligible for reimbursement. |
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Complete this form if you are transferring from one agency to another and would like to ensure uninterrupted FSA/DCAP enrollment. |
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This guide provides detailed information about how the FSA program works. |
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This guide provides detailed information about how the DCAP program works. |
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This guide provides detailed information about how the FSA program works. |
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This guide provides detailed information about how the DCAP program works. |
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