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Get the free FLEXIBLE SPENDING ACCOUNT ENROLLMENT APPLICATION - Cooper Union

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Clarity Benefits SolutionsFLEXIBLE×SPENDING×ACCOUNT×ENROLLMENT×APPLICATIONPlan×Year×January×1, 2017×through×December×31, 2017Employer×Employee×Last×Name×First×Name×Social×Security×Numerate×of Hire×Address×City×State_*Zip//Phone ()(Check×here×for×mobile×device)*Email×Address* Required×fieldsOption×I: Medical×Reimbursement×Account (Health×FSA)Enter×annual×pretax×contribution×amount×up to×your×companies’m
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How to fill out flexible spending account enrollment

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How to fill out flexible spending account enrollment

01
Step 1: Obtain the flexible spending account enrollment form from your employer.
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Step 2: Read the instructions carefully before filling out the form.
03
Step 3: Provide your personal information, such as your name, address, and social security number.
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Step 4: Specify the coverage period for the flexible spending account.
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Step 5: Determine the contribution amount you wish to allocate to the account.
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Step 6: Indicate the eligible expenses you plan to use the funds for, such as medical or dependent care expenses.
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Step 7: Sign and date the form.
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Step 8: Submit the completed form to your employer or the designated department for processing.

Who needs flexible spending account enrollment?

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Flexible spending account enrollment is available to employees who want to set aside pre-tax dollars to cover eligible expenses.
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It is particularly beneficial for individuals who anticipate regular medical or dependent care expenses.
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Those who want to reduce their taxable income and save money on taxes can benefit from enrolling in a flexible spending account.
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Flexible spending account enrollment is a benefit program that allows employees to set aside pre-tax dollars for eligible healthcare expenses.
Employees who wish to participate in a flexible spending account program offered by their employer are required to file for enrollment.
Employees can typically fill out flexible spending account enrollment forms provided by their employer during the open enrollment period.
The purpose of flexible spending account enrollment is to help employees save money on eligible healthcare expenses by using pre-tax dollars.
Typically, employees must report their desired contribution amount and select eligible healthcare expenses to be covered by the flexible spending account.
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