FORMS can be printed, downloaded, completed and faxed or mailed back to us. Address and fax information is provided on each form.

PDF files require Adobe Reader for viewing. Adobe Reader can be downloaded for free at: http://www.adobe.com/products/acrobat/readstep2.html

Flex Spending Account ENROLLMENT FORMS:

File: FLEX-Enrollment-Authorization Form: This is a generic form, call CPA Inc if you need information on your plan specs

File: FLEX-City of Boston                                    Enrollment-Authorization Form:

Premium Only Account Forms:

File: POP-Section 125                                  Enrollment-Authorization Form:

Flex Spending Accounts CLAIM FORMS:

File: FLEX-Claim Reimbursement Form:

File: FLEX-City of Newton                                           Claim Reimbursement Form:

Flex Spending Accounts MISCELLANEOUS FORMS:

File: FLEX-Direct Deposit Sign-up Form:

File: FLEX-Dependent Care Certification Form:

File: FLEX-Over-the-Counter Medications List:

File: FLEX-Required Physician's Letter:

HRA/CO-PAYMENT REIMBURSEMENT FORMS:

File: HRA                                                            Claim Reimbursement Form:

File: Town of North Attleboro                            CoPay Reimbursement Form: