Flexible Spending Election Form (SPPS)

 

This form is a fillable PDF. 

1 - Download the form to your computer

2 - Fill it out on your computer, save

3 - Email completed form to benefits@spps.org

 

Use this form when:

New Hire - Do not use this form, election is made when completing your benefits enrollment online.

Qualifying Status Change - Change in daycare

This form is not used during Open Enrollment.  Online enrollment required annually.

 

FSA_FSAD_Election_Form_2020_Fillable.pdf, 282.68 KB; (Last Modified on April 14, 2020)