Get 2011 Flexible Spending Account - St Jude

Filling out the 2011 Flexible Spending Account (FSA) form for St. Jude can streamline your healthcare and dependent care expenses. This guide provides a step-by-step approach to ensure you accurately complete the form online.

Follow the steps to successfully complete your FSA form.

1. Press the ‘Get Form’ button to access the FSA form and open it in your preferred editing tool.
2. Begin by entering your personal information in the designated fields, including your name (last, first, middle), social security number (SSN), employee number, and plan number (P30563).
3. Input your address details: street, city, state, and zip code. Also, provide your date of birth and gender.
4. Enter your spouse's name, SSN, and date of birth if you wish to include them in your application.
5. Indicate your participation choice by checking the box for 'I want to participate in our Flexible Spending Account (FSA).' This confirms your intent to contribute funds.
6. Enter the total annual election amounts for both health care and dependent care. Note the minimum and maximum limits applicable.
7. If you do not wish to participate, check the box for 'I decline to participate in our FSA.' Ensure you are aware that you will not be eligible to re-enroll until the next plan year unless there is a qualifying change in your situation.
8. Sign the form to certify your selections, and provide the date signed, making sure it is prior to the effective date of the plan year.
9. If choosing direct deposit for reimbursements, complete the Direct Deposit Authorization section with your banking information. Specify if it is a checking or savings account and provide all required details.
10. Review all entered information for accuracy before saving your changes. You may then download, print, or share the completed form as needed.

Complete your FSA form online today to maximize your benefits.