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You can download and print the following forms to use for your retirement and/or cafeteria plan. In order to view PDF-based forms (), you must have Adobe Reader installed on your computer. You can download the Reader free of charge from Adobe.

To download the form for storage on your computer, you can right click on the PDF icon and choose "save target as" option. You will then be prompted for a folder location.

Want to learn more about retirement and cafeteria plans? Browse through the Knowledge Center for helpful articles and presentations.

Need help navigating the Participant Portal? Use these helpful tutorials to learn all the ins and outs.

DayPak Retirement Forms
Form/
Purpose
View/
Download

Beneficiary Designation:
Use this form to establish or change your beneficiary.


27 kb


Special Tax Notice:
This form provides you with possible federal income tax treatment of distributions from your retirement plan.


30 kb
FlexPak Cafeteria Forms

FLEXIBLE SPENDING ACCOUNT Claim Form:
Use this form to submit for reimbursement of medical and dependent daycare expenses.

2.5MB

HRA (HEALTH REIMBURSEMENT ARRANGEMENT) Claim Form:
Use this form to submit for your health reimbursement arrangement expenses.

1.2MB

NEW - HRA/FSA Claim Form (please use this form if your company has a FSA and HRA):
Use this form to submit your FSA and HRA expenses.

65 KB

List of IIAS Merchants


Information Release Form

Direct Deposit Authorization:
Use this form to set up direct deposit of your reimbursement checks.

Dependent Care Verification Form:
Use this form to verify eligibility of your daycare provider.

Eligible Expenses for Dependent FSAs:
This provides a partial list of reimbursable dependent care expenses from your dependent FSA.

Health Care Expense Table
Access a list of up-to-date eligible medical expenses for your medical FSA. You will need a password to access this special feature. If you need the password, contact FlexPak by phone at (866) 353-9725 or by email at flexpak@swerdlin.net. Please include your name and company in the email.