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  1. Home
  2. FlexComp Plan Forms

FlexComp Plan Forms

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Forms Policy

  1. Digital signatures are not accepted by NDPERS.
  2. Completed forms must be submitted to NDPERS by fax, by mail, or as a scanned PDF.
  3. NDPERS does not accept picture files such as .jpeg, .jpg, .tif, or .png.

Select a form to download:

  • Continuation of Coverage in a Medical Spending Account (SFN 53512)
  • FlexComp Change in Status (SFN 53511)

Other general forms

  • Authorization to Release Confidential Information (SFN 61324)
  • Notice of Change for Name & Address (SFN 10766)

Copyright © 2021
ND Public Employees Retirement System
1600 East Century Avenue, Suite 2 | PO Box 1657 | Bismarck, ND 58502-1657
P: 701.328.3900 | TF: 800.803.7377 | F: 701.328.3920
https://www.ndpers.nd.gov/contact/

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