Claim Forms

Before you submit a claim, review page 1 of the claim form, “How to Submit Claims.” You can also submit claims online by clicking the Online Access/Account Detail tab above and then selecting Participant/Account Detail. Or, you can snap a picture of your documentation and submit via the ASIFlex mobile app.

Claim Form	PDF	Word
General FSA Claim Form
HRA Claim Form
Mass Transit/Van-Pooling/Parking
State of Arizona Employees
State of California FlexElect
State of California Pre-Tax Parking
North Dakota Retirees
San Diego County Employees
Iowa State University Employees
State of Missouri Employees
Vassar HRA Claim Form