University of Southern California
 

 

 

Forms

The following forms are available to be downloaded to your printer. Once completed, please return them to the Office of Benefits Administration. Please note that additional documentation is often required to accompany some forms. If you do not have Adobe Acrobat on your computer, you may down-load it from the ITS Web site.

 

Flexible Spending Accounts (FSA)

FSA Health Care Claim Form

FSA Dependent Care Claim Form

FSA Orthodontia Guidelines

 

 

 

 

 

 

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