NYS Flex Spending Account 2012 Forms
Submit Your Claims Online
You can now submit your reimbursement requests online through myFBMC.com. This process allows you to submit, via FBMC’s secure website, a scanned image of your completed claim form along with scans of your supporting documentation.
First time users should follow the instructions to complete the New Users registration process. After you have registered at myFBMC.com, logon, click on the Claims tab, then select "Online FSA Claim Submission" from the drop down box.
Health Care Spending Account Forms
|Letter Of Medical Need Form|
|HCSAccount Reimbursement Request Form and Instructions (PDF VERSION) (FILL-IN FORM VERSION)|
|Personal Use Items/Special Foods Form|
|Capital Expenditure Worksheet|
Dependent Care Advantage Account Forms
|NYS Network Child Care Centers Listing|
|DCAAccount Reimbursement Request Form (PDF VERSION) (FILL-IN FORM VERSION)|
|DCAAccount Reimbursement Request Form Instructions (PDF VERSION)|
|Enter The RACE (Direct Deposit) Form (PDF VERSION)|