Forms

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Retirement Forms

  • Beneficiary Designation: Use this form to establish or change your beneficiary.
  • Special Tax Notice: This form provides you with possible federal income tax treatment of distributions from your retirement plan. 

Health and Welfare Forms

  • Authorization for Direct Debit: Complete this form to authorize Swerdlin to directly debit your checking or savings account for the amount you indicate to repay ineligible expenses.
  • Authorization for Direct Deposit: Complete this form to have claim reimbursement funds from your FSA and/or HRA deposited directly to your personal bank account.
  • Dependent Care Credit vs. Dependent Care FSA: This document is a reference to show a comparison between claiming a Tax Credit on dependent care versus using a Dependent Care FSA.
  • Debit Card FAQ: This document covers frequently asked questions about the Benny Debit Card.
  • Dependent Care Verification Form: Complete this form for Swerdlin to verify the eligibility of your daycare provider.
  • EBIA's Health Care Expenses Table: This is a comprehensive list of eligible medical expenses. The access code is "swerdlin2005".
  • Eligible Expenses for Dependent Care FSA: This document is a partial list of eligible expenses you may be reimbursed for through your Dependent Care FSA as well as a list of ineligible expenses.
  • Eligible Expenses for Medical FSA: This document is a partial list of eligible expenses you may be reimbursed for through your Medical FSA as well as a list of ineligible expenses.
  • FSA Claim Form: Complete this form to receive reimbursement from your Flexible Spending Account.
  • FSA Claim Form w/ Transit and Parking: Complete this form to receive reimbursement from your Flexible Spending Account and/or your Transit and Parking Accounts.
  • FSA Website InstructionsThis document provides step by step instructions for using our participant website.
  • HIPAA Notice: This document provides disclosure of Swerdlin's privacy practices.
  • HIPAA Release FormComplete this form if you would like to authorize anyone other than yourself to have access to your medical and claims information.
  • How Much Will You Save: This form allows you to calculate potential savings earned through using a Medical and/or Dependent Care Flexible Spending Account.
  • HRA Claim Form: Complete this form to receive reimbursement from your Health Reimbursement Arrangement.
  • HRA and FSA Claim Form: Complete this form to receive reimbursement from your Flexible Spending Account and/or your Health Reimbursement Arrangement.

Learn more about Swerdlin

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Why Swerdlin?

Although we have clients nationwide, we're still a family company at heart. 

Featured page thumbnail

Our Services

Swerdlin provides services for all types of retirement and cafeteria plans to clients nationwide. Learn how we can help you!

Featured page thumbnail

Resources

Click here for our collection of forms, calculators, useful links, and frequently asked questions.

Featured page thumbnail

Our Values

Balance. Integrity. Relationships. Development. 

Why Swerdlin?

Although we have clients nationwide, we're still a family company at heart. 

Our Services

Swerdlin provides services for all types of retirement and cafeteria plans to clients nationwide. Learn how we can help you!

Resources

Click here for our collection of forms, calculators, useful links, and frequently asked questions.

Our Values

Balance. Integrity. Relationships. Development.