Printable Forms, Guides & Brochures

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Frequently Used Forms
HRA Reimbursement Request (CLAIM) Form	HRA, COBRA	View/Download/Print
Quote Request	HSA, HRA, FSA, INSUR	View/Download/Print
HRA Application	HRA	View/Download/Print
HRA Employer Guide	HRA	View/Download/Print
HRA Employee Guide	HRA	View/Download/Print
Authorized Representative(HIPAA) Form	HRA, FSA, COBRA	View/Download/Print
myRSC First Time Login Guide	HRA, FSA, HSA, COBRA	View/Download/Print
myRSC Employer Portal Guide	HRA, FSA, HSA, COBRA	View/Download/Print
myRSC Employee Portal Guide	HRA, FSA, HSA, COBRA	View/Download/Print
IRS Publication 502 - Medical Expenses	HRA, FSA, HSA	View/Download/Print
IRS Publication 969 - Reimbursement Accounts	HRA, FSA, HSA	View/Download/Print
Direct Deposit Enrollment/Change Form	HRA, FSA, COBRA	View/Download/Print
Receipt and Substantiation Form - Debit/Credit Card Transactions	HRA, FSA, COBRA	View/Download/Print
HRA Reimbursement Request (CLAIM) Form	HRA, COBRA	View/Download/Print
Eligible Dependent Care Expenses	FSA	View/Download/Print
Dependent Care Reimbursement Request Form	FSA	View/Download/Print
Substantiation Requirements	HRA, FSA, COBRA	View/Download/Print
Employee mySource card Agreement Application	HRA, FSA, HSA,COBRA	View/Download/Print
Additional Card Request Form	HRA, FSA, HSA,COBRA	View/Download/Print

HRA Enrollment
HRA Employer Guide	HRA	View/Download/Print
HRA Quote Request	HRA,	View/Download/Print
HRA Application	HRA	View/Download/Print
HRA Employee Guide	HRA	View/Download/Print
Employee mySourceCard Enrollment	HRA	View/Download/Print
Authorized Representative Form	HRA, COBRA	View/Download/Print

Reimbursement and Substantiation
Qualifying Child and Relative Questionnaire	FSA,	View/Download/Print
Eligible Dependent Care Expenses	FSA	View/Download/Print
FSA Deductible Verification Form	FSA	View/Download/Print
IIAS Merchant List	HRA, FSA, HSA, COBRA	View/Download/Print
90% Rule Merchant List	HRA, FSA, HSA, COBRA	View/Download/Print
Medically Necessary Form	HRA, FSA, HSA, COBRA	View/Download/Print
Receipt and Substantiation Form - Debit/Credit Card Transactions	HRA, FSA, COBRA	View/Download/Print
HRA Reimbursement Request (CLAIM) Form	HRA, COBRA	View/Download/Print
Substantiation Requirements Refresher	HRA, FSA, HSA, COBRA	View/Download/Print

Administrative
myRSC Employer Portal Guide	HRA, FSA, HSA	View/Download/Print
Authorized Representative Request Form (HIPAA)	HRA, FSA	View/Download/Print
Benefits Termination Form	HRA, FSA, COBRA	View/Download/Print

Plan Implementation
HRA Employer Guide	HRA	View/Download/Print
HRA Employee Guide	HRA	View/Download/Print
myReourceCard® Credit card Information for Employees	HRA, FSA, HSA	View/Download/Print
myResourceCard® credit card Setup for Employer	HRA, FSA, HSA	View/Download/Print
mySourceCard® debit card Information for Employees	HRA, FSA, HSA	View/Download/Print
mySourceCard® debit card Setup for Employer	HRA, FSA, HSA	View/Download/Print
Direct Deposit Enrollment Change Form	HRA, FSA	View/Download/Print
myRSC Employer Portal Guide	HRA, FSA, HSA	View/Download/Print
myRSC Employee Portal Guide	HRA, FSA, HSA	View/Download/Print
IRS Publication 502 - Medical Expenses	HRA, FSA, HSA	View/Download/Print
IRS Publication 969 - Reimbursement Accounts	HRA, FSA, HSA	View/Download/Print
Receipt and Substantiation Form - Debit/Credit Card Transactions	HRA, FSA	View/Download/Print
Dependent Care Reimbursement Request Form	HRA, FSA	View/Download/Print
Substantiation Requirements	HRA, FSA	View/Download/Print
Additional Card Request Form	HRA, FSA, HSA	View/Download/Print

HSA Forms and Information
HSA Qualified Insurance INDIVIDUAL/FAMILY Quote Request	HSA	Request Quote
HSA Qualified Insurance Group Quote Request	HSA, INSUR	View/Download/Print
HSAtoday Fee Schedule	HSA	View/Download/Print
HSAtoday Enrollment Form	HSA	View/Download/Print
HSAtoday mySourcecard Debit Enrollment Form	HSA	View/Download/Print
HSAtoday Deposit Slip	HSA	View/Download/Print
HSAtoday Investment Guide	HSA	View/Download/Print
HSAtoday PHI Release Form	HSA	View/Download/Print
HSAtoday Rollover Form	HSA	View/Download/Print
HSAtoday Distribution Request Form	HSA	View/Download/Print
HSAtoday Expense Form	HSA	View/Download/Print
IRS Form 8889 Health Savings Accounts	HSA	View/Download/Print

INSURANCE
AWB MASTER APPLICATION	INSUR	View/Download/Print
AWB HealthChoice 2500 HSA BENEFITS	HSA, INSUR	View/Download/Print
AWB HealthChoice Employee Ins Enrollment/Change Form	INSUR	View/Download/Print
AWB HealthChoice Employee Health Statement Form	INSUR	View/Download/Print
AWB HealthChoice Employee Waiver of Coverage Form	INSUR	View/Download/Print
Multi Termination Form	HSA,HRA,FSA,COBRA,INSUR	View/Download/Print
Insurance Group Quote Request and Application	HSA, INSUR	View/Download/Print
Individual/Family Temp Insurance Quote and Application	HSA, INSUR	Get Quote and Application
Individual/Family Health Insurance Quote Request and Application	HSA, INSUR	Get Quote and Application
IRS Forms and Publications
IRS Form W-9	HSA, HRA, FSA, INSUR	View/Download/Print
IRS Publication 502 - Medical Expenses	HSA, HRA, FSA, COBRA	View/Download/Print
IRS Publication 503 - Child and Dependent Care Expenses	HSA, HRA, FSA	View/Download/Print
IRS Publication 969 - Reimbursement Accounts	HRA, FSA, HSA, COBRA	View/Download/Print
IRS Form f8853 Archer MSAs and LTC	MSA, LTC	View/Download/Print
IRS Form f8889 Health Savings Accounts	HSA	View/Download/Print