FlexComp Plan Forms

Forms Policy

1. Digital signatures are not accepted by NDPERS.
2. Completed forms must be submitted to NDPERS by fax, by mail, or as a scanned PDF.
3. NDPERS does not accept picture files such as .jpeg, .jpg, .tif, or .png.

Select a form to download:

• FlexComp Enrollment (SFN 53851) - Newly eligible participants only
• FlexComp Change in Status (SFN 53511)
• Continuation of Coverage in a Medical Spending Account (SFN 53512)

Other general forms

• Authorization to Release Confidential Information (SFN 61324)
• Notice of Change for Name & Address (SFN 10766)