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Office use only FSA Open Enrollment Oct. 1 Oct. 31, 2018Approved by:Approved date:FSA 2018 Corrections (see dates below)Effective date:Submit this completed form to your agency/university benefit
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Start by gathering all the necessary information such as full name, email address, phone number, and physical address.
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Begin by writing your full name accurately in the designated field.
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Provide a valid email address that you frequently use as a primary mode of contact.
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Enter your phone number in the specified format and provide an alternate number if applicable.
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Write your complete physical address including street name, building number, city, state, and zip code.
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Contact information includes phone number, email address, and mailing address.
All individuals and businesses are required to file contact information.
You can fill out contact information online or on a paper form provided by the relevant authority.
The purpose is to ensure that individuals and businesses can be contacted for important notifications and updates.
Phone number, email address, and mailing address must be reported.
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