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Click ‘Get Form’ to open it in the editor.
Complete Part A: Participant Information. Fill in your name, employee ID, finance number, pay location, employing office details, daytime telephone number, and mailing address.
If you wish to begin pre-tax treatment, navigate to Part B and select the option to elect pre-tax treatment of your FEHB health insurance premium contributions. Ensure you understand the IRS guidelines mentioned.
If waiving pre-tax treatment (only if previously elected), go to Part C and indicate your choice to waive pre-tax treatment.
In Part D, sign and date the form after reading the Privacy Act Statement. This confirms your understanding of the pre-tax treatment process.
Finally, submit the completed form through our platform for processing by Human Resources.
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May 12, 2021 Our Annual Report on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K and amendments to those reports filed or furnished.
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