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Employee Forms

DCAP Recurring Service/Expense Claim Form

Reimbursement Account Employee Direct Deposit Authorization Form

Enrollment Agreement Additional Card Request/Replacement Card Request

Authorization for Release of Information

Debit Card Substantiation Request Form/Claim Form

HSA Request for Distribution Form

HSA Application and Salary Reduction Agreement

HSA Transfer Request Form

MyRSC Debit Card Substantiation Reimbursement Form

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Little Rock, AR 72215
Phone: 501-687-6954
Toll-free: 877-685-0655
Fax: 855-445-1696
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