Seattle Department of Human Resources Susan Coskey, SDHR Director

FORMS

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Forms

AD&D

Change in Family Status


Deferred Compensation

Family Medical Leave

Flexible Spending Account

  • FSA Reimbursements for Claims Only
  • pdf icon  Claim Reimbursement Form
    Form used to submit reimbursement request for eligible health and dependent care expenses.
  • word document icon FSA Change Form
    Make allowable changes to current address, status or contributions for health and/or dependent care.
  • pdf icon Benefits Card/Direct Deposit Request Form
    Form to authorize reimbursements to be deposited directly into your bank account and/or request for pre-paid Benefits Card to pay for qualified health care expenses up front.

Life Insurance

Long Term Disability Insurance

For the LTD claims packet, please contact your department's benefits representative.

Medical & Health Care

Military

Open Enrollment

Paid Parental Leave

Privacy Policy

Publications