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2010 - 16.5¢
IRS Eligible Expenses List
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ChangeofStatus.com
IRS Publication 502
BenefitLink.com
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Medical and Dental Expenses
IRS Publication 503
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Employee Forms
Interactive Claim Voucher (requires Adobe Acrobat/Acrobat Reader version 6.02 or later)
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Direct Deposit Application
Debit Card Enrollment Application
Medical Expense Worksheet
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HIPAA Privacy Statement and Authorization
HRA Enrollment Form w/ Debit Card
HRA Enrollment Form w/o Debit Card
HRA Activation Form
HRA Claim Form (How To)
HSAToday™ Expense Detail and Request for Distribution
HRA Employer Forms
Confidential Information for HRA Documents
Pacific Benefit Consultants, Inc.
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3090 Fite Circle, Suite 101 - Sacramento, CA 95827
(916) 363-2101 - (800) 800-2090
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