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Paychex fsa claim form 2026
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- Click ‘Get Form’ to open the Paychex FSA Claim Form in the editor.
- Begin by filling out your personal information in Section 1, including your name, social security number, and contact details.
- In Section 2, select your enrollment options. Indicate whether this is a new enrollment or a change in status.
- Proceed to Section 3 to enter your annual election amounts for medical/dental/vision and dependent care. Ensure these do not exceed the allowed limits.
- Review all entries for accuracy before signing in Section 4. This confirms your understanding of the terms and conditions.
- Once completed, save the document and submit it via our platform or print it for mailing.
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