Get Arpi Payflex Form

The Arpi Payflex Form is a vital document that allows users to authorize the release of personal information to designated individuals or organizations. Completing this form online is straightforward, and this guide provides clear, step-by-step instructions to assist you in filling it out accurately.

Follow the steps to complete the Arpi Payflex Form online

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin with Section A, which requires the participant's information. Provide the member number, full name (first, middle initial, last), social security number (last four digits only), and the address including city, state, and zip code.
3. Proceed to Section B to input the recipient information. Here you will name the person or organization you are authorizing to receive the participant’s information. Fill in their name, address, relationship to the participant, and check the appropriate box if there are multiple recipients.
4. In Section C, specify the information to be released. Choose between granting full account privileges, limited account privileges, or specific account privileges as detailed in the section. Only select one option.
5. If you wish to revoke or cancel any authorization, complete Section D. Fill in the name of the recipient whose privileges you are revoking, along with your printed name, signature, and date.
6. Finally, complete Section E by signing and dating the authorization. Ensure that you understand that this authorization will expire after twelve months unless revoked sooner.
7. After filling out all sections accurately, save your changes, and prepare to submit the form by faxing it to 1-402-231-4300 or mailing it to PayFlex Systems USA, Inc., P.O. Box 3039, Omaha, NE 68103-3039. Remember to keep a copy for your personal records.

Complete your Arpi Payflex Form online today!