Useful Forms and Documents

 

Form Type/Document File Type Description
PDF
Submit this form in order to request reimbursement for your out-of-pocket expenses. Please note that you will need to include a detailed service statement (NOT JUST PROOF OF PAYMENT) in order for your reimbursement request to be approved.
PDF
Submit this form in order to enroll in the Medical or Dependent Care Reimbursement Accounts. Please note that you can only enroll mid-year if you experience a qualifying event.
PDF
Complete this form to request a reimbursement from your Pre-Tax Parking Program account.
PDF
Complete this form to start or modify your monthly deduction in the Pre-Tax Parking Program.
Microsoft Word
If you would like to have another individual be able to call ASIFlex and access detailed information about your account, please complete this form.
Microsoft Word
Certain medical expenses require that this form be completed by your medical provider in order for them to be eligible for reimbursement.
PDF
This guide provides detailed information about how the Flex Elect program works.
PDF
This guide provides detailed information about how the DCAP program works.
PDF
Complete this form if you would like to request a Qualified Distribution of your unused Medical Reimbursement Account.