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A more detailed certification from me). Employee Signature: (Employee Signature must be provided in order to process this form) Date: 1934 Olney Avenue * Suite 200 * Cherry Hill, NJ 08003 FSAclmfrm-Rev.03/2011 Contact Information & Claims Submission: 888-599-1515 856-470-1200 800-238-0876 (Fax) flexclaims iaatpa.com IAA - PO Box 5082 Mt. Laurel, NJ 08054 www.iaatpa.com FSA/HRA Claim Form Documentation Medical Payments All documentat.

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