header.gif Aurora, photo credit Jan Curtis 2003 Closeup photo of man in office setting Closeup of flower, photo credit Nile Mueller Woman at Sitka campus, photo credit UAS Mt. McKinley, photo credit © Rex Melton, Alaska Division of Tourism Woman in UAS Environmental Science field class, photo credit UAS UAS HR UAF HR UAA HR UA Human Resources Home University of Alaska Home
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HR Employee Forms

Flexible Spending Account Forms:

Form Name Available Formats
(Icon Legend)
Form Descriptions
FSA Claim For Medical And Dependent Care Form Adobe PDF format file Computer enterable Adobe PDF format file To submit a claim for your flexible spending account.
FSA Direct Deposit For Medical And Dependent Care Form Adobe PDF format file To establish direct deposits of flexible spending account payments.
UA Choice Supplemental Benefit Election Form - FY09 Open Enrollment Adobe PDF format file To add or delete employee selected benefits and/or deductions - i.e., FSA, AD&D, and other employee selected deductions such as accounts payable, parking, United Way, etc. (7/1/08-6/30/09).
UA Choice Supplemental Benefit Election Form - FY08 Adobe PDF format file Computer enterable Adobe PDF format file To add or delete employee selected benefits and/or deductions - i.e., FSA, AD&D, and other employee selected deductions such as accounts payable, parking, United Way, etc. (7/1/07-6/30/08).

 

Please email syhr about any problems with this page   21-Apr-2008

  Photo credits: woman in field class and woman at Sitka campus photos courtesy of UAS; Mt. McKinley photo credit © Rex Melton,
Alaska Division of Tourism; flower photo credit Nile Mueller; aurora photo credit Jan Curtis 2003