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Winchester Service Center News June 2009 FSA County Committees: Clark/Powell USDA Service Center 30 Taylor Avenue Winchester, KY 40391 859 745-2828 866 470-6778 (toll-free) Hours Monday Friday 8:00

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1. Start by obtaining the 21049200906 1doc - fsa form. This form should be available from your employer or benefits administrator.
2. Read the instructions carefully. It is important to understand the requirements and guidelines for completing the form accurately.
3. Begin by entering your personal information, such as your name, address, and social security number, in the designated fields.
4. Fill out the sections related to your health care expenses. This may include information on medical, dental, or vision expenses incurred during the year.
5. Provide details on your Flexible Spending Account (FSA) contributions and withdrawals, if applicable. This may involve specifying the amounts contributed to the account and any reimbursements received.
6. Ensure that all the information provided is accurate and consistent with your records. Double-check for any errors or omissions that may affect the validity of the form.
7. Review the completed form to ensure it is legible and all necessary sections have been filled out. Make sure to sign and date the form appropriately.
8. Submit the form as instructed by your employer or benefits administrator. Keep a copy for your records.

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1. Employees who have a Flexible Spending Account (FSA) through their workplace may need to fill out the 21049200906 1doc - fsa form. This form is typically used to report and document eligible expenses for reimbursement from the FSA.
2. Individuals who have incurred qualified medical, dental, or vision expenses throughout the year and wish to seek reimbursement may also need to fill out this form.
3. Employers or benefits administrators who manage the FSA program may require individuals to complete the 21049200906 1doc - fsa form as part of the process for managing and administering the benefits program.

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