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FSA SECONDARY CARD REQUEST From This form authorizes a secondary FSA debit card to be issued to your FSA account. NOTE: Any person issued an FSA debit card must read the Cardholder Agreement issued
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How to fill out fsa secondary card request

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How to fill out an FSA secondary card request:

01
Obtain the FSA secondary card request form from your employer or FSA provider. This form is typically available online or through your HR department.
02
Fill out your personal information accurately. Provide your full name, address, date of birth, and employer information as requested. Make sure to double-check for any spelling mistakes or inaccuracies.
03
Indicate the reason for the secondary card request. This could include adding a dependent or spouse to your FSA account, replacing a lost or stolen card, or updating your information.
04
If you are adding a dependent or spouse, provide their full name, social security number, and relationship to you. This information is necessary for the FSA provider to link the secondary card to the correct account.
05
If you are replacing a card, clearly state the reason and submit any additional documentation required. This may include a police report in the case of a stolen card or an affidavit attesting to the loss of the original card.
06
Review the form for completeness and accuracy before submitting it. Ensure that all required fields are filled and all necessary documents are attached.

Who needs an FSA secondary card request:

01
Employees with flexible spending accounts (FSAs) who wish to add a dependent or spouse to their account.
02
Employees who have lost or had their FSA card stolen and need a replacement card.
03
Individuals whose personal information or employment status has changed and require an update to their FSA account.
Remember to check with your employer or FSA provider for specific instructions or additional requirements regarding the FSA secondary card request process.
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FSA secondary card request is a request for an additional card linked to a Flexible Spending Account (FSA) account.
Any individual who wants to have a secondary card linked to their FSA account is required to file the request.
To fill out an FSA secondary card request, the individual must provide their personal information, FSA account details, and any other required information on the designated form or online portal.
The purpose of the FSA secondary card request is to provide convenience and flexibility for individuals to access and use their FSA funds.
The FSA secondary card request typically requires personal information, FSA account details, contact information, and authorization to issue the secondary card.
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