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FLEXIBLE SPENDING ACCOUNT BENEFIT ENROLLMENT FORM Employer Name: SS # Employee Name: Division: Plan Year: Street Address: City:, State:, Zip Code: Email: To elect amounts for the next plan year, please
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To fill out the question "What are flexible," follow these points:

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Q What Are Flexible is a flexible questionnaire designed to gather information.
All employees are required to file Q What Are Flexible.
Q What Are Flexible can be filled out online or in paper form.
The purpose of Q What Are Flexible is to collect data on flexible work arrangements.
Information such as type of flexible arrangement, hours worked, and any challenges faced.
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