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NC FLEX 83126 CLAIM FORM AND INSTRUCTIONS If you have any questions regarding benefits available, or how to file your claim, or if you would like to appeal any determination, please contact our Customer
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This form is a document used for reporting flexible spending account contributions and expenses.
Employees who have participated in a flexible spending account during the tax year are required to file this form.
The form should be filled out by providing information on contributions made to the flexible spending account and expenses incurred. It is important to accurately report all information.
The purpose of this form is to report contributions to and expenses from a flexible spending account, for tax purposes.
Information such as contributions made to the flexible spending account, expenses incurred, and any reimbursements received must be reported on this form.
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