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Health Care / Dependent Care Reimbursement Account (HCRA/DCRA) Enrollment Form

The HCRA/DCRA Enrollment Form allows a new or existing employee to enroll or make changes to their HCRA and/or DCRA account.

Launch the HCRA/DCRA Enrollment Form

Applicant Instructions

  1. After launching the HCRA/DCRA Enrollment Form, an Adobe Sign Form will prompt you for your name and email.
  2. Complete all required fields
  3. The following information is needed to complete the HCRA-DCRA Enrollment Form
    • Employee Information: Name, SSN, and marital status.