Get Payflex Pf-111-1 2016-2025

Filling out the PayFlex PF-111-1 form online is a straightforward process that allows you to enroll in various reimbursement accounts. This guide provides comprehensive instructions to help you complete each section of the form accurately and efficiently.

Follow the steps to complete your PayFlex PF-111-1 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the Employer Use Only section, enter the Employer ID Number and select whether this is a re-enrollment, new enrollment, or a change. Also, provide the effective date and first payroll deduction date, and choose the payroll mode from the options provided.
3. In section A: Personal Information, fill in your employer's name, your first name, middle initial, last name, social security number, street address, city, state, ZIP code, email address, date of birth (MM/DD/YYYY), and date of hire (MM/DD/YYYY). Ensure that you print clearly and complete each section.
4. In section B: Election Information, indicate if you wish to participate in the benefit choices by checking 'Yes' or 'No.' If 'Yes,' list your pre-tax deduction amounts for both Health Care Flexible Spending Account (FSA) and Dependent Care Flexible Spending Account (DCFSA) along with the number of pay periods.
5. Review the statements regarding your election and responsibilities. Ensuring you understand these terms is crucial as they outline your obligations regarding contributions, changes, and claims.
6. If you wish to enroll in direct deposit for reimbursements, complete section C by authorizing PayFlex to initiate entries to your account. Remember to include a 'voided' check or savings deposit slip with your application.
7. Finally, provide your signature and the date at the bottom of the form to certify that all information is correct and your participation in the program is as described.
8. Once you have filled out the form, ensure to save your changes. You can also download, print, or share the completed form as needed.

Complete your PayFlex PF-111-1 form online today to ensure your benefits are fully utilized.