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Note: Forms are in PDF format. You will need Adobe® Acrobat Reader to read PDF files.

Claim Forms

Enrollment and Change Requests

These forms are fillable forms. If you need a copy that you can print and complete by hand, please contact your employer.

Additional Forms

To file an appeal please visit,

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

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