Get Fx-3017-011305 Change Of Election Form.pmd - Freidag

Filling out the FX-3017-011305 Change Of Election Form is a crucial step for individuals looking to make changes to their benefit elections. This guide will provide you with clear and concise instructions to ensure a seamless completion of the form.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your participant name and ID number in the designated fields at the top of the form.
3. Write the effective date of the change along with the first payroll affected by the change.
4. Select the type of change you are requesting and fill out the payroll deduction amounts along with any revised annual elections for areas such as medical expenses, dependent/daycare accounts, and group insurance premiums.
5. Indicate the reason for the change by checking the appropriate box related to your situation, such as a change in legal marital status or change in employment status.
6. Sign and date the form in the participant signature section. Ensure that your client also signs and dates the form if required.
7. Retain a copy of the completed form for your records. Communicate any changes of election to FlexSystem using the Payroll Verification Report, which can be found online.

Ensure to complete your documents online and reach out for assistance if needed.