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The University of VermontCalendar Year 2021 Flexible Spending Account Enrollment Form Send completed form to Human Resources Services via uvm.edu/filetransfer to HRSinfo@uvm.edu EMPLOYEE INFORMATION: (Last)(First)(M.I.)EMPLOYEE
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01
To fill out Form 16 - flex spending, follow these steps:
02
Start by carefully reading the instructions provided on the form.
03
Provide your personal information such as name, address, and Social Security Number.
04
Enter your employer's details including their name, address, and Employer Identification Number (EIN).
05
Fill in the appropriate sections that pertain to your contributions and expenses for flex spending.
06
Include any dependent care expenses or medical expenses that qualify for flex spending.
07
Calculate the total amount of eligible expenses and enter it in the designated field.
08
Sign and date the form to certify that the information provided is accurate.
09
Keep a copy of the form for your records and submit the completed form to the relevant authority.

Who needs 16 - flex spending?

01
Form 16 - flex spending is needed by individuals who have eligible medical and dependent care expenses and wish to take advantage of flex spending accounts provided by their employers.
02
Those who want to set aside pre-tax money to cover these expenses can use this form to track and report their eligible expenses.
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16 - flex spending refers to a flexible spending account (FSA) option that allows employees to set aside pre-tax dollars for eligible medical expenses.
Employees who have opted to participate in a flexible spending account (FSA) for healthcare expenses are required to file for 16 - flex spending.
To fill out 16 - flex spending, gather all necessary receipts for eligible expenses, complete the appropriate forms provided by your employer or FSA administrator, and submit them as directed.
The purpose of 16 - flex spending is to allow employees to use pre-tax dollars to pay for qualified medical, dental, and vision expenses, reducing their taxable income.
On 16 - flex spending, individuals must report total contributions, eligible expenses claimed, and any remaining balance at the end of the plan year.
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