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Boulder Valley School District 2017 Flexible Benefits Plan Enrollment (Section 125 Plan) For calendar year January 1, 2017, December 31, 2017, Name (please print) School/Worksite Home Address City
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How to fill out flexible spending enrollment form

How to fill out flexible spending enrollment form
01
Read the instructions on the flexible spending enrollment form.
02
Gather all the necessary information such as your employer's details, employee identification number, and personal details.
03
Carefully review the different sections of the form, including the eligibility requirements and coverage options.
04
Fill out your personal information accurately, including your full name, address, and contact details.
05
Provide your employee identification number or any other required identification information.
06
Indicate the desired coverage period and the amount you wish to contribute to the flexible spending account.
07
Specify the types of eligible expenses you plan to use the funds for, such as medical, childcare, or transportation costs.
08
Review all the information filled out on the form to ensure its accuracy.
09
When submitting the form, make sure to sign and date it.
10
Submit the completed form to the appropriate department or person designated by your employer.
Who needs flexible spending enrollment form?
01
Employees who want to take advantage of tax advantages for medical expenses, dependent care, or transportation costs.
02
Individuals who have access to a flexible spending account benefit offered by their employer.
03
Those who anticipate incurring eligible expenses throughout the coverage period and want to set aside pre-tax dollars for these costs.
04
People who are willing to carefully estimate their annual expenses and understand the use-it-or-lose-it rule associated with flexible spending accounts.
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What is flexible spending enrollment form?
Flexible spending enrollment form is a document that allows employees to enroll in a flexible spending account (FSA) to set aside pre-tax money for eligible healthcare or dependent care expenses
Who is required to file flexible spending enrollment form?
Employees who wish to enroll in a flexible spending account are required to file the flexible spending enrollment form
How to fill out flexible spending enrollment form?
Employees can fill out the flexible spending enrollment form by providing their personal information, selecting the desired contribution amount, and signing the document
What is the purpose of flexible spending enrollment form?
The purpose of the flexible spending enrollment form is to allow employees to allocate pre-tax funds for eligible healthcare or dependent care expenses
What information must be reported on flexible spending enrollment form?
Information such as personal details, contribution amount, and signature must be reported on the flexible spending enrollment form
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