MCPS FORMS > STAFF FORMS > Flexible Spending Account Calendar Year 2012 Election

Flexible Spending Account Calendar Year 2012 Election

During Open Enrollment, you may enroll in your flexible spending account(s) online. Enrolling online is the fastest and most secure way to enroll in a flexible spending account and will allow you to receive immediate confirmation of your elections. Search “flexible spending” from any MCPS webpage for additional information. If you choose not to enroll online, please complete, sign, and return this form to the Employee and Retiree Service Center. You may fax this form to 301-279-3651 or 301-279-3642 or e-mail an electronically signed Adobe PDF file to ERSC@mcpsmd.org. org. Please only submit your elections via one method. Submitting via multiple methods can cause errors and delay the processing of your elections. Please visit the ERSC website for additional information. A confirmation of your elections will be sent to your MCPS employee e-mail.

• This form is for: MCPS Staff
• Form number: 450-3
• Last revised: October 2011

Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat