NYS Flex Spending Account 2017 Forms
If you need a form for the 2016 plan year, please choose from the 2016 plan year forms list instead of the list below.
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
Dependent Care Advantage Account Forms
|Online DCAAccount Change In Status Application|
|DCAAccount SAMPLE Reimbursement Form|
|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)|