FlexCorp Downloadable Forms

Downloadable Forms

If you are an FCP Flexible Spending Account participant, you may download the following forms as needed. (Some employers use their own versions of these forms. If you are not sure if you should use these forms, please contact your Human Resource manager.) These forms are in PDF format; therefore, you will need Acrobat Reader to view and print each. If you do not have Acrobat Reader, you may download it (free of charge) from the Adobe website.

• HRA Reimbursement Request Form
Download and complete this form to request reimbursement associated with your HRA.

• FSA Reimbursement Request Form
Download and complete this form to request reimbursement associated with your FSA.

• Direct Deposit Enrollment Form
Download and complete this form to request a direct deposit.

• Request FlexCard for Dependent
Complete this form to request an additional Flex Card.

• FlexCard Receipt Submission Form
Download and complete this form to verify your recent FlexCard purchases

• HSA Contribution/Withdrawal Form
Use this Conbribution/Withdrawal Form to obtain Funds from or to deposit funds in your Health Savings Account with HSA Bank.

• Parking & Transit Claim Form
Use this form to report parking and transit expenses.

• Instructions for the Setup of Online Account Access
Use this form to report parking and transit expenses.

• Examples of Eligible and Ineligible FSA Expenses

* Keep in mind, per federal guidelines, a FSA participant can only terminate his/her FSA participation during the benefit enrollment period unless he/she experiences a "Change of Life Status."

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