How to Submit a Claim for FSA

Explains how to submit a Medical or Dependent Care reimbursement claim under your FSA plan.

How to Submit A Claim For HRA

Explains how to submit an Medical claim under your HRA plan.

Request for Reimbursement Claim Form

Claim form for submitting Medical Expense and/or Dependent Care claims under your FSA plan.

Employee Direct Deposit Authorization Form

Form to request that your claim reimbursement be deposited directly into your bank account.

Dependent Care Claim Form

Claim form for submitting Dependent Care claims under your FSA plan.

mySourceCard® Debit Card Substantiation Request Form

Claim form for submitting receipts to substantiate a debit card transaction, i.e., to verify the eligibility of items or services paid for using your mySourceCard debit card.

mySourceCard® Additional or Replacement Card Request Form

Form to request replacement of a lost or stolen debit card or to have a new card issued for a dependent.

Recurring Expense Form for Dependent Care

HSA Request for Distribution Form

HSA Application for State of Arkansas and Schools (only)

HSA Account Transfer Form

FSA Educational Materials and Forms

Materials to help enrollment go more smoothly and to keep participants well informed. Includes FAQs, eligible expenses, how to fill out claim forms, and more. (Click to download .zip file.)

FSA Educational Video

Explain the benefits of opening an FSA account. (Click to download .zip file.)

HSA Educational Materials and Forms

Materials to help enrollment go more smoothly and to keep participants well informed. Includes Top 10 Reasons, eligible expenses, and more. (Click to download .zip file.)

HSA Educational Video

Explains the benefits of opening an HSA account. (Click to download .zip file.)

YouTube Channel

Effectively communicating the facts about benefit options can increase participation rates dramatically. Embed these videos on your website, post to social media, display on video monitors, etc.

FSA Carryover Print Materials

Informative flyers and posters on the FSA CarryOver plan option. (Click to download .zip file.)

Arkansas Society for Human Resource Management (SHRM)

Provides leadership, communication, training, and support for human resource professionals, while also demonstrating and promoting HR excellence and ethics.

Employment Law and Legislative Affairs (ELLA)

Annual conference conducted by the Arkansas SHRM chapter to educate and enlighten on important employment law and legislative issues.

Employers Council on Flexible Compensation (ECFC)

Lobbies Congress to enable innovative employers to provide cutting-edge benefits and compensation.

EBIA Benefits Compliance (Thomson Reuters Checkpoint)

Authoritative compliance publications written and edited by experienced benefits attorneys that provide an “insider’s guide” to plan design and administration issues.  Part of Thomson Reuters since 2007.

Arkansas Public Employees HR Association (APEHRA)

An affiliate of the International Public Management Association for Human Resources (IPMA-HR), APEHRA works in association with the Arkansas Municipal League to promote excellent in human resources, personnel management, and administration in Arkansas municipalities and towns.

Arkansas Association of Legal Administrators (ALA)

Promotes and enhances the competence and professionalism of all members of the legal management team.

Arkansas Hospital Association (AHA)

Works for the betterment of hospitals through education, government relations, research and communication.

American Society of Pension Actuaries (ASPA)

National organization of benefits professionals dedicated to the preservation and enhancement of the private pension system in America.

Independent Payroll Providers Association (IPPA)

National association of privately held companies whose primary function is the preparation of payroll and payroll taxes for employers of all sizes.

Integrated Benefits Institute

Open to employers, insurers, health care providers, brokers, consultants and others interested in the evolution of integrated benefits.

International Foundation of Employee Benefit Plans (IFEPB)

Largest educational association serving the employee benefits and compensation industry.

Million Dollar Round Table (MDRT)

Premier association for the world’s best sales professionals in the life insurance-based financial services business.

National Association of Alternative Benefit Consultants (NAABC)

Professional “non-commercial” trade organization that represents insurance producers and brokers across the United States who market Health Savings
Accounts, Health Reimbursement Arrangements and other Consumer Driven Health Plans to individuals and employers/groups.

National Institute of Pension Administrators (NIPA)

National association representing the retirement and employee benefit plan administration profession.

Risk and Insurance Management Society (RIMS)

Serves member entities by proactively providing products, services and information to manage all forms of business risk.

Self-Insurance Institute of America (SIIA)

Largest national non-profit association dedicated to protecting and promoting the self-insurance risk financing alternative for both employee benefits and workers’ compensation.

Internal Revenue Code

Quick reference guide to Internal Revenue Code (IRC) sections affecting employee benefit plans.

Employee Benefits Regulations

Quick reference guide to employee benefits regulations in regard to income tax, ERISA, and related issues.

Employee Retirement Income Security Act (ERISA)

Quick reference guide to Title 29 of the United States Code (USC), including ERISA which became law in 1974.

ERISA Filing Acceptance System (EFAST)

Information for Qualified Form 5500 preparers.


Excellent source for employee benefit information and tools.

The Claim Line

Provides a forum for insurance information exchange.

Employee Benefit Research Institute (EBRI)

Committed exclusively to data dissemination, policy research and education on economic security and employee benefits.

Bureau of Labor Statistics (BLS) Employee Benefits Survey

Comprehensive data on the incidence (the percentage of workers with access to and participation in employer provided benefit plans) and provisions of selected employee benefit plans.

National Committee for Quality Assurance

Reports on the nation’s Managed Care Organizations.

An independent Health Savings Account source containing HSA information, news, insurance quotes, solutions, custodial accounts, and rates for individuals and companies.

Bureau of Labor Statistics (BLS)

Principal fact-finding agency for the federal government in the broad field of labor economics and statistics.

Congress Today

Tells you who your Congress members are, how to get in touch with them, what they are discussing and how they voted.

Decisions of the U.S. Supreme Court

Supreme Court cases from the point they first appear in the court’s regular order lists, including information on certiorari grants and denials and amici. On cases the court agrees to hear, also includes summaries of the question or questions presented. Maintained by the Legal Information Institute.

Department of Labor (DOL)

Cabinet-level department of the U.S. federal government responsible for occupational safety, wage and hour stands, unemployment insurance benefits, reemployment services, and some economic statistics.

Department of Veteran Affairs (VA)

Provides information on VA programs, veterans’ benefits, VA facilities worldwide, and VA medical automation software.

Federal Register (FR or Fed.Reg.)

Official journal of the U.S. federal government, containing government agency rules, proposed rules, and public notices.

Code of Federal Regulations (CFR)

Codification of the general and permanent rules and regulations (sometimes called ‘administrative law’) published in the Federal Register by the executive departments and agencies of the U.S. federal government.

Centers for Medicare and Medicaid Services (CMS)

Federal agency within the U.S. Department of Health and Human Services (HHS). Programs for which CMS is responsible include Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), HIPAA, and CLIA.

Internal Revenue Service (IRS)

Tax information, publications and forms.

Employee Benefits Security Administration (EBSA)

Division of the DOL that provides information on pensions, health plans and other employee benefits.

Social Security Administration (SSA)

Frequently asked questions, benefit calculators, account management tools and much more.

U.S. Bureau of Census

Principal agency of the U.S. Federal Statistical System, responsible for producing accurate demographic data on the American population and economy.