Forms
- Authorization to disclose information (PDF)
- Autopay Enrollment Form (PDF)
- Certification of Dependent Status (PDF)
- Change of Address Form (PDF)
- Claim Form - Commuter Expense Reimbursement Account (CERA) (PDF)
- Claim Form - FSA Healthcare Account (FSA) (PDF)
- Claim Form – Dependent Care Account (DCA) (PDF)
- Direct Deposit Form (PDF)
- Letter of Medical Necessity (PDF)
- Status Change (PDF)
Send forms to:
Flexible Spending Accounts Administration & CERA
P.O. Box 67230
Portland, OR 97268-1230
888-249-5058 Fax toll free
