PDF
Word
Leave of Absence (Loa) Form - Health Care Flexible Spending Account (FSA) - Delaware
Leave of Absence (Loa) Form - Health Care Flexible Spending Account (FSA) is a legal document that was released by the Delaware Department of Human Resources - a government authority operating within Delaware.
FAQ
Q: What is a Leave of Absence Form?
A: A Leave of Absence Form is a document that employees use to request time off work for various reasons.
Q: What is a Health Care Flexible Spending Account (FSA)?
A: A Health Care Flexible Spending Account (FSA) is a type of account that allows individuals to set aside pre-tax money to pay for eligible healthcare expenses.
Q: What is the purpose of the Leave of Absence Form for the Health Care Flexible Spending Account?
A: The purpose of the Leave of Absence Form for the Health Care Flexible Spending Account is to notify the plan administrator of a leave of absence and to determine eligibility for continuation of FSA benefits during the leave.
Q: Who can use the Leave of Absence Form for the Health Care Flexible Spending Account?
A: Any employee participating in a Health Care Flexible Spending Account who needs to take a leave of absence can use this form.
Form Details:
- The latest edition currently provided by the Delaware Department of Human Resources;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Delaware Department of Human Resources.
