• FSA Claim Form
• List of Eligible and Ineligible Expenses for Health Care Reimbursement

For more information about eligible expenses and qualifying relatives for the Health Care reimbursement account, refer to IRS publication 502.

For more information about qualifying dependents and eligible expenses for the Dependent Care reimbursement account, refer to IRS publication 503.

Both publications can be found at www.irs.gov/