FSA_Form_Example_tinypng

Enrollment Forms

Select from the 2026 document library shown below. 

ACCRUELOGO

FSA Only

Use this form if you are enrolling in just a flexible spending account

HSA ONLY

For those enrolling in just a health savings account

COMMUTER Only

When electing just a commuter account

all benefits

Enrolling in all available benefits for you

dcap ONLY

Use to enroll in just a dependent care assistance plan

fsa & dcap

To enroll in both flexible spending and dependent care plans

FSA & LFSA & DCAP

Use this form if you are enrolling in flex, limited flex, and DCAP

questions

We're available to assist with any questions to help you choose the right forms