Administered by FBMC Benefits Management

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Virginia DOA Provider Network Vendor Information

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Required Forms

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Payroll Schedules

Payroll/HR Contacts Listing (Excel)

Required Forms
Post-Tax Salary Deduction Agreement (SDA)
Pre-Tax Salary Reduction Agreement (SRA)
Cash Match Form (CMF)
Salary Reduction Agreement Form: 403(b) Plan 15-Year Catch-up Election Form

FBMC Benefits Management
3101 Sessions Road, Tallahassee, FL  32303
844-822-4968,  (fax) 850-514-5803

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