Forms

• Claim Reallocation (PDF)
• Dependent Care Claims (PDF)
• HealthCare Claims (PDF)
• Direct Deposit (PDF)

Send forms to:
Flexible Spending Accounts Administration & CERA
P.O. Box 67230
Portland, OR 97268-1230
503-765-3554 Fax
877-277-7279 Fax toll free