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  • Flexible Spending Account (fsa) Employee Change In Status Form

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Flexible Spending Account (FSA) Employee Change in Status Form Instructions: Submit this form and supporting documentation to make a change to your current FSA election within 30 days of a change.

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Where does the money go? Unused FSA money returns to your employer. The funds can be used towards offsetting administrative costs incurred during the plan year, employers can also reduce annual premiums in the next FSA year, or funds must be equally distributed to employees who enroll in an FSA for the next year.

To change your FSA contributions, complete and submit a Request for Change in Status form. In most plan years, certain qualified changes in status may provide an opportunity in which you may start or stop participating, or change the amount of your FSA contribution during the plan year.

Yes, you may change your election and allotment amount (FSA contribution) as often as you want during the Open Season timeframe .

IRS Regulations require that FSA elections for the new plan year must be made no later than the last day of the prior plan year and are irrevocable unless the employee experiences a permitted election change.

The IRS defines change in status as: Change in participant's legal marital status – including marriage, divorce, death of a spouse, legal separation, and annulment. Change in number of dependents – including birth, adoption, placement for adoption, and death.

IRS Regulations require that FSA elections for the new plan year must be made no later than the last day of the prior plan year and are irrevocable unless the employee experiences a permitted election change.

You generally must use the money in an FSA within the plan year. But your employer may offer one of two options: A grace period of up to 2.5 extra months to use the money in your FSA3. Carrying over up to $610 per year to use in the following year5.

This is crucial to remember if you're switching jobs, because unlike retirement accounts, you cannot roll the money into a new account. However, you can elect to start a new account with your new employer, even if it's within the same year. Note that your maximum contribution resets when you start a new job.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232