New York State's Flexible Spending Accounts - NYS Flex Spending Account 2012 Forms

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

Online HCSAccount Change In Status Application

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

Online DCAAccount Change In Status Application

NYS Network Child Care Centers Listing

DCAAccount Reimbursement Request Form (PDF VERSION) (FILL-IN FORM VERSION)

DCAAccount Reimbursement Request Form Instructions (PDF VERSION)

Other Forms