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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		To submit a claim for your flexible spending account.
FSA Direct Deposit For Medical And Dependent Care Form		To establish direct deposits of flexible spending account payments.
UA Choice Supplemental Benefit Election Form - FY10 (For coverage period of July 1, 2009, through June 30, 2010.)		To add or delete employee selected benefits and/or deductions (e.g. FSA, AD&D, Supplemental Life) during the plan period of July 1, 2009, through June 30, 2010.
UA Supplemental Life Evidence of Insurability (EOI) Form - FY10 (For coverage period of July 1, 2009, through June 30, 2010.)		Employees electing more than $200,000 in supplemental life coverage are required to complete the evidence of insurability form and submit it to their HR office along with with the UA Choice Supplemental Benefit Election Form.