Benefit Forms

 


Flexible Spending Account (FSA)
Dependent Care Assistance Program (DCAP)

2017 FSA & DCAP Enrollment Form
FSA & DCAP Change Form Allows you to make changes to an account for qualifying events.
2016 FSA & DCAP Claim Form
2017 FSA & DCAP Claim Form
FSA Direct Deposit Authorization/Flexi-Card Enrollment
Recurring Day Care Claim Instruction Guide

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Health Savings Account (HSA) 

2017 Employee Authorization for Payroll Deduction to HSA
Health Savings Account Beneficiary Designation

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Public Employees Retirement Plan (PERS)/Teachers Retirement Plan (TRS)

Member Information Form (for Civil Service, Bargaining Unit and Hourly)
Higher Education Employees Plan 3 Investment Program Form  (for Faculty and Administrative Professional)
Beneficiary Designation
Plan 3 Change of Investment Program: Choose between the Washington State Investment Board (WSIB) and the Self-Directed Investment Programs.
Name & Address Change : To be completed by inactive members, retirees and beneficiaries receiving benefits. Active members update your address through MyWSU account.
VEBA Enrollment Form

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Washington State University Retirement Plan (WSURP), TIAA

Retirement Participation Election Form
How To Enroll Online Guide

10% Increased Contribution: At any time following your 50th birthday you may elect to increase your contribution rate to 10%.
Paper Enrollment Form: Use this form to enroll by mail. Use the How to Enroll Online Guide above to enroll online.
VEBA Enrollment Form
Change of Name: Use this form to update your name on your retirement account. Return completed form to address noted on top of form.
Beneficiary Change via TIAA website: Update your beneficiaries online.

Voluntary Investment Plans

2017 Salary Reduction Agreement: Use this form to designate your desired contribution for the TIAA-CREF Voluntary Investment Plan.
Deferred Compensation Participation Agreement: Use this form to designate your desired contribution for the Deferred Compensation Program (DCP).

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Washington State University