1. Gather and scan documentation that serves as proof of the life event – either the final, signed/dated Decree for Dissolution of marriage (divorce) or the Decree for Dissolution of state-registered domestic partnership.

It is not necessary to scan and provide the entire Decree – the only pages required are those that include the names of the parties, any dates/date stamps, and the signature of the presiding judge (often the first and last pages of the Decree).

2. Complete the Dependent Loss of Eligibility: Divorce/Dissolution form, linked below. You will upload the supporting documentation from step 1 as part of submitting the form.

Take me to the form

Upon submitting the form, your request will receive a unique reference number (starting with “REF”) as well as an email indicating that your request was received.

You can decrease or stop your FSA contributions up to 60 days after the date of your finalized divorce/dissolution, due to the loss of a tax dependent’s eligibility.

1. Gather and scan documentation that serves as proof of the life event – either the final, signed/dated Decree for Dissolution of marriage (divorce) or the Decree for Dissolution of state-registered domestic partnership.

It is not necessary to scan and provide the entire Decree – the only pages required are those that include the names of the parties, any dates/date stamps, and the signature of the presiding judge (often the first and last pages of the Decree).

2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

Effective Date
The change to your FSA contribution amount is effective the 1st day of the month following the later of:

1. The date of loss of eligibility,
   -OR-
2. The date you submit your requested changes in Workday.

If the later of a. or b. is the 1st day of the month, the change takes effect that day.