Forms

• Adult Children – Plan Amendment Request Form (PDF)
• Commuter Expense Account Claim Form (PDF)
• Claim Form – Dependent Care Account (DCA) (PDF)
• Claim Form – FSA Healthcare Account (HCA) (PDF)
• Flexible Spending Account Direct Deposit Form (PDF)
• Enrollment Spreadsheet (Excel)

Send forms to:
Flexible Spending Accounts Administration & CERA
P.O. Box 67230
Portland, OR 97268-1230
503-765-3554 Fax
888-249-5058 Fax toll free