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Video instructions and help with filling out and completing Rev proc 2009-41
Diversified administration is proud to announce our new election form and I'd like to take just a moment to explain some of its features as the form is customized for each employer the employer's name will already be filled out the rest of the fields in the participant information section are pretty self-explanatory once you've completed the information in a particular field simply hit the tab key to move to the next field in the coverage information section begin by putting in the date that the current plan year starts if you're unsure of the date either call us or your human resources department next indicate whether or not you'll be participating in the medical portion of the FSA plan if you select yes before entering the effective date of the plan you'll receive an alert reminding you to fill out that date if you'll be participating in the medical reimbursement benefit enter the amount you would like to contribute for the year the medical limit is currently twenty five hundred dollars so if you enter an amount higher than that an alert will pop up and ask you to enter an amount at or below the limit the number of pay periods will already be filled in and won't need to be changed except by human resources when they're completing this form for people joining the plan mid-year based on the annual election a number of pay periods in the plan year the form will automatically calculate the per payroll deduction amount finish this section by checking the box detailing the terms of this benefit next indicate whether or not you'll be participating in the dependent care reimbursement benefit just as with the medical reimbursement benefit will enter the annual election amount if the amount is higher than the plan limit of five thousand dollars and alert will pop up informing you of this once that's been entered the form will again calculate the per payroll deduction finish this section by checking the boxes detailing the terms of this benefit now indicate whether or not you'll be participating in the health savings account benefit if you've done all this the employee signature field should appear at the bottom of the election form if not you'll see text in red which says the signature field will appear once the rest of the form has been completed to see what fields need to be completed for the signature field to appear click the submit via email button to the right clicking the submit by email button will then pop up and alert and indicate what needs to be done before the form can be digitally signed once all of the required fields have been completed click the digital signature box an alert will pop up prompting you to save the form using your first and last name after you save the file a dialog box will appear if you already have a digital signature select that from the drop-down box.