Forms & Documents

Find, download, and print the forms you need for the Flexible Spending Account benefit for State of Iowa employees.

FSA Forms

• ASIFlex Card Order Form (233.56 KB) .pdf
• Claim Form (fill-in) (412.75 KB) .pdf
  • View a Claim Sample (377.69 KB) .pdf
• Prepayment form (197.56 KB) .pdf (for retirees)
• Direct Deposit and Paperless Notification

FSA Documents

• FSA Brochure (645.82 KB) .pdf
• FSA Store Cardless Pay Instructions (803.79 KB) .pdf
• Terminated Employee Information (238.38 KB) .pdf
• Summary Plan Description (1018.72 KB) .pdf
• Plan Document (1.62 MB) .pdf