Note

There are three (3) items on this webpage; please scroll to view all items.

1) Open enrollment presentation

2) FSA informational booklet

3) FSA enrollment form

Enrollment Kit for FSA with Dependent Care

View this document to learn more about the Flexible Spending Account (FSA)

Download the Enrollment Kit for Health FSA with Dependent Care

Enrollment form for FSA

 

  1. ALL fillable fields on form MUST be completed.
  2. Please see enrollment instructions email for form password.
  3. Completing the form is a two-step process.
    1. When you are ready to submit the form, fill out the signature line. A blue "Click to Sign" button will appear in the lower right corner.
    2. When you click on the blue button, you will be directed to enter your email address.
    3. You will receive a confirmation email from Adobe Sign (echosign@echosign.com) with the subject line, "Please confirm your signature on CDS OE 2019 FSA."
    4. Click on the link in the email to confirm your email address.
    5. You will receive a final copy of your enrollment form when you have confirmed your email address.
    6. Your enrollment form submission is not complete until you have received the second confirmation email.
    7. You may refresh this webpage to complete the health and other insurance enrollment form.

 

 

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