Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your online document editor.
2. Begin by providing your personal information in the designated fields, including your name, employer, mailing address, Social Security Number (SSN), email, date of birth, and daytime phone number.
3. In the job/pay information section, indicate how often you are paid by selecting the appropriate option: 'Weekly', 'Bi-weekly', 'Semi-Monthly', or 'Other'. Also, indicate your department.
4. For the Flexible Spending Account (FSA) Benefit Selections, specify the amount you wish to elect for your Health Care FSA and Dependent Care FSA. Ensure you understand the eligibility requirements for each type of FSA.
5. Fill in any applicable annual FSA plan administration fee, if required.
6. In the Direct Deposit section, indicate your agreement for salary reduction and understand the terms regarding fund utilization and eligibility.
7. Sign and date the form to certify your information is correct and that you agree to the terms stated.
8. Once you have completed the form, save your changes, and you can proceed to download, print, or share the form as needed.

Complete your forms online to ensure timely enrollment and manage your benefits effectively.