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Forms & documents

Find the form you need.

Benefit forms and resources for participants, families, and employers.

Choose a form below. Online forms open with the existing provider; PDF documents open in a new tab.

EBT Trust Forms

Online form

Direct Deposit/ Paycard Form

Open form Online form

Supplemental Unemployment Verification Form

Open form PDF document

Third Party Authorization

Open form PDF document

EBT Beneficiary Form

Open form PDF document

Federal Withholding Form

Open form PDF document

New York Withholding Form

Open form

General Benefit Forms

PDF document

Dependent Care Claim Form

Open form PDF document

FSA Claim Form

Open form PDF document

FSA Expense Worksheet

Open form PDF document

FSA Mileage Claim Form

Open form PDF document

HRA Claim Form

Open form PDF document

HRA/FSA Claim Form

Open form PDF document

Request for COBRA Letter

Open form Online form

Merit Alliance QSEHRA Form

Open form

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