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Pima County Special Interest Classes May to August 2014 3500 West River Road Tucson, AZ 85741 520-877-6290 www.pima.gov/nrpr IMPORTANT REGISTRATION INFORMATION Please read carefully before you register.
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How to fill out ASI FSA CHG form:
01
Begin by carefully reading the instructions provided on the form.
02
Fill in your personal information accurately, including your name, contact information, and employee identification number.
03
Identify the type of change you are making by selecting the appropriate option from the form.
04
If applicable, provide details regarding the change you are making, such as the effective date or the reason for the change.
05
If there are any supporting documents required, make sure to attach them securely to the form.
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Sign and date the form to certify that the information provided is accurate.
08
Submit the completed ASI FSA CHG form according to the instructions provided, whether it be through mail, email, or an online submission portal.
Who needs ASI FSA CHG form:
01
Employees who are enrolled in a flexible spending account (FSA) and need to make changes to their account information, such as updating their dependent information, changing their contribution amount, or modifying their coverage.
02
Individuals who have experienced a qualifying life event, such as marriage, the birth of a child, adoption, or a change in employment status, which necessitates a change in their FSA.
03
Employees who wish to make adjustments to their FSA mid-year due to changes in their healthcare needs or expenses.
Note: It is always advisable to consult with your employer or the entity responsible for managing your FSA to confirm if the ASI FSA CHG form is the appropriate document for your specific situation and to obtain any additional guidance or requirements.
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