Independent Health Flexible Spending Account (FSA) Enrollment for UB Foundation (UBF)

Enroll in Independent Health's Flexible Spending Account (FSA). This is for use with the UB Foundation (UBF).

Learn more about your FSA

Download the Form

Independent Health Flexible Spending Account (FSA) Enrollment form

Mobile Users

For the best experience in completing this form use a non-mobile device.

Using Firefox with PDF forms?

Make Adobe Acrobat the reader.

Completing the PDF Form

  1. Read through all pages of the document to find specific instructions
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:

Campus Mail

UB Foundation
Center for Tomorrow
North Campus

External Mail (USPS)

UB Foundation
P.O. Box 900
Buffalo, NY 14226-0900

Need help completing the form?

Send email, phone or submit a question

Joyce Weeman

Benefits Specialist

UB Foundation

Phone: 716-645-8731

Email: joycewee@buffalo.edu

Jahaira Shaver

Payroll & Benefits Administrator

UB Foundation

Phone: 716-645-8733

Email: jahairal@buffalo.edu

 
 
(We'd like to respond to you.)
(Required)

Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: June 7, 2011

Owner: UB Foundation