Claim Forms

Before you submit a claim, review the Claim Filing Requirements to insure you understand what is required so that you can be sure to get your money back fast. Remember you can submit a completely paperless FSA claim form online by clicking Online Access/Account Detail above and then selecting Participant.

Claim Form	PDF	Word
General FSA Claim Form
HRA Claim Form
Mass Transit/Van-Pooling/Parking
State of Arizona Employees
Arizona Board of Regents FSA Claim Form
Arlington County FSA Claim Form
State of California FlexElect
State of California Pre-Tax Parking
California State University
City County Insurance Services (CIS)
North Dakota Retirees
San Diego County Employees
State of Colorado Employees
State of Delaware Employees
State of Iowa Employees
Iowa State University Employees
State of Missouri Employees
State of Nebraska Employees
University of Colorado Employees
Vassar HRA Claim Form