Get Prepayment Form - State Of Iowa - Das Hre Iowa

This guide provides clear and concise instructions for completing the PREPAYMENT FORM as part of the State of Iowa's Health Flexible Spending Account program. It is designed to assist users in filling out the necessary information accurately and efficiently.

Follow the steps to fill out the PREPAYMENT FORM online.

1. Press the ‘Get Form’ button to access the PREPAYMENT FORM and open it in your document editor.
2. In the first section, enter your last name, first name, and middle initial (MI) as prompted. Ensure the information is printed clearly.
3. Next, provide your Social Security Number (SSN). This is required to verify your participation in the health flexible spending account program.
4. Certify your participation by stating the date of your last paycheck in the provided space. Write clearly to avoid processing issues.
5. In the declaration section, indicate your understanding that deductions will be taken from your final paycheck to cover your annual commitment for the health flexible spending account.
6. Sign and date the form at the bottom, confirming the information provided is accurate.
7. Finally, choose your method of submission: either fax the completed form to 877-879-9038 or mail it to the specified address: ASIFlex, PO Box 6044, Columbia, MO 65205-6044.
8. Review your completed form for accuracy, then save your changes. You also have the option to download, print, or share the document as needed.

Complete your documents online with confidence!