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Flexible Spending Account Forms

Election Forms

FSA Plan for UCC Ministries Election Form and Compensation Reduction Agreement Form 2021

FSA Plan for UCC Ministries Change in Status Election Form

FSA Plan for UCC Ministries Revocation of Benefit Election and Compensation Reduction Agreement Form

FSA Plan for UCC Ministries Election Not to Participate Form

 

Health FSA

FSA Plan for UCC Ministries Medical Care Expense Claim Form

Qualifying Medical Care Expenses Worksheet

 

Dependent Care FSA

FSA Plan for UCC Ministries Dependent Care Claim Form

Qualifying Dependent Care Expenses Worksheet