The Pension Boards - PBUCC - Flexible Spending

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Flexible Spending Account Forms

We recently updated our forms and applications. Please select the link for the applicable benefits in which you want to enroll and complete the application.

Election Forms

FSA Plan for UCC Ministries Election Form and Compensation Reduction Agreement Form 2022

FSA Change in Status Form

Health FSA

FSA Plan for UCC Ministries Medical Care Expense Claim Form

Qualifying Medical Care Expenses Worksheet

Dependent Care FSA

FSA Plan for UCC Ministries Dependent Care Claim Form

Qualifying Dependent Care Expenses Worksheet