CSI Flexible Benefits Forms
Claim Form for Health Care and Dependent Care Expense Accounts
Complete the Arcadia FSA Claim form and attach supporting documentation for reimbursement of health care and/or dependent care expenses. Please note that you can speed your reimbursement by faxing your claim to the number at the bottom of the form.
Change in Benefit Election Form
Complete the Change in Benefit Election Form for mid-year election changes due to an IRS “change in status”.
Direct Deposit Authorization Form
Complete the Direct Deposit Authorization Form to have your Flexible Spending Account (FSA) reimbursements deposited directly into your checking or savings account or to change your checking or savings account numbers.
Employee Status Change Form
The school must complete the Employee Status Change Form when an employee has a name change, address change, termination of employment or leave of absence.
Cash Compensation in Lieu of Benefits Form
Click here to obtain the enrollment and authorization form for Cash Compensation in Lieu of Benefits.
