Get the free 2012 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)

This document is used for employees in the City of Springfield to enroll in a Flexible Spending Account (FSA) and to authorize annual election amounts for various health and dependent care expenses.

How to fill out 2012 enrollment and change

How to fill out 2012 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)

1. Obtain the 2012 Enrollment and Change Form for the Flexible Spending Account (FSA) from your employer or benefits administrator.
2. Read the instructions carefully to understand the form's requirements and deadlines.
3. Fill in your personal information in the designated sections, including your name, address, and employee ID number.
4. Indicate your desired contribution amount for the FSA in the appropriate section, ensuring it adheres to the contribution limits.
5. Specify the type of enrollment (new enrollment, change in election, or cancellation) in the corresponding box.
6. Review any additional options or benefits offered and mark your selections as needed.
7. Sign and date the form to confirm your application or change.
8. Submit the completed form to your HR department or benefits administrator by the specified deadline.

Who needs 2012 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)?

1. Employees who want to participate in a Flexible Spending Account (FSA) for pre-tax medical expenses.
2. Individuals looking to change their current FSA contribution amount or make updates to their account.
3. New hires wanting to enroll in the FSA during their onboarding process.

People Also Ask about

What is the tax form for FSA?

Do FSAs roll over? FSAs generally have a strict “use-it-or-lose-it” mandate, which means any money left over at the end of each year must be forfeited.

Can you change FSA after enrollment?

You can elect to participate in an FSA during open enrollment and you must select a contribution amount at that time. You cannot make any changes or opt out of the FSA later in the year.

How to get a letter of medical necessity for FSA?

For health and limited health FSAs, you don't have to file anything with your return. You must file Form 2441 with your return if you have a dependent care FSA.

For pdfFiller’s FAQs

What is 2012 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)?

The 2012 Enrollment and Change Form for Flexible Spending Account (FSA) is a document used by employees to enroll in or modify their participation in a flexible spending account program offered by their employer.

Who is required to file 2012 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)?

Employees who wish to enroll in or make changes to their existing Flexible Spending Account for the year 2012 are required to file this form.

How to fill out 2012 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)?

To fill out the form, employees need to provide personal information such as their name, employee ID, and the specific changes they wish to make regarding their FSA contributions and benefits.

What is the purpose of 2012 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)?

The purpose of the form is to allow employees to either enroll in a new FSA plan or make changes to their existing FSA contributions, ensuring they can allocate pre-tax dollars for eligible medical or dependent care expenses.

What information must be reported on 2012 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)?

The form must include the employee's name, contact information, employee ID, the type of changes being made, and the amount to be allocated to the FSA for the year 2012.