As a service to our members, we are making the most commonly requested forms available for download in Adobe^® Acrobat^® portable document format (PDF). Simply click on the title of the form you wish to download.

	Authorization Agreement for Direct Deposit
	FSA Election Form
	FSA Claim Form
	Transportation Claim Form
	Change in Status Form
	Check Reissue Form
	FSA Eligible Expense List
	Over-The-Counter Drug Listing
	Benny Card Dispute Form

Below, please find the IRS publications that provide guidance for filing your federal tax return. They can be used as references for expenses that may be considered eligible under the FSA program. Please be advised that not all expenses that can be claimed on your tax return are eligible for reimbursement under the FSA program.

Insurance premiums of any type cannot be reimbursed under the FSA program.

	IRS Publication 502 - Medical and Dental Expenses
	IRS Publication 503 - Child and Dependent Care Expenses
	IRS Publication 969