Get the free Revised PrimeFlex -Form#12 - HRA Authorization of Plan Renewal
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Office Use Only Date Processed: Processed by: / / Client #: Reflex Form #12: HRA Authorization of Benefits Plan Renewal Employer Information: Employer Name: Street: HRA Plan Year: City: State: Zip
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Who needs revised primeflex -form12:
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Revised primeflex -form12 is a form used for reporting flexible spending account information.
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The purpose of revised primeflex -form12 is to report information related to flexible spending accounts for tax purposes.
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Information such as contributions, withdrawals, reimbursements, and account balances must be reported on revised primeflex -form12.
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