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Flexible Spending Accounts Program
DeCAP > Claims, Reimbursements, and Statements

DeCAP Claims
To request reimbursement for dependent care expenses under DeCAP, you must complete a DeCAP Claims Form. Filing a claim is easy:
  1. List each expense and dependent separately on the Claims Form, and
  2. Have the dependent care provider sign and date the form and provide his/her name, address, and Federal Tax ID or Social Security Number.
Receipts and billing statements are not needed for DeCAP.

All claims must be submitted directly to the FSA Administrative Office and received by the last day of the month in order to be processed for that month. You will only be reimbursed for dependent care expenses that are provided during the applicable Plan Year.


  • No reimbursement can be made prior to the service actually being provided.
  • No reimbursement can be made for any expense incurred while you and/or your spouse are not at work or attending school full-time (i.e., sick leave, maternity leave, summer vacation, etc.).
Claims should be submitted in a timely manner. A Claims Run-Out Period is provided, until February 28th following the close of the Plan Year, to submit claims for services performed during the previous period of coverage.

Although eligible dependent care expenses of any amount are reimbursable, the total amount of expenses on a DeCAP claims form must be $50.00 or greater, unless your current account balance is less than $50.00.

Note: There is no Grace Period available for DeCAP.

Download FSA Program Forms & Brochures 

DeCAP Claims Denial
If, for any reason, it is necessary for the FSA Administrative Office to deny a claim, you will receive a denial letter stating the reason for denial.

You may appeal the denial by filing a written appeal with the Appeals Panel within 60 days after your receipt of the denial notice. The Appeals Panel will review your claim and make a determination within 60 days after receipt of your written notice for appeal.

DeCAP Reimbursements
Reimbursement for approved claims processed during one month will be automatically deposited into the account you indicated on your Enrollment/Change Form or Direct Deposit Form by the close of the following month.  Or you may choose to have reimbursement checks sent to your home address.

Claims will only be reimbursed up to the current balance in your account. If for any reason there are insufficient funds in your account to cover the expenses claimed, only that portion of your claim for which there are sufficient funds will be reimbursed. The balance will be carried forward to the next month for payment.

If a claim exceeds your balance at the end of the Plan Year, you will receive a check exhausting your account.

Note: Payments will be made directly to you and not to the service provider.

DeCAP Account Statements
Every month, you will receive a statement indicating your opening account balance, all contributions to your account, processed claims, a maximum account administrative fee of $4.00 per month, and your closing account balance.

After the Claims Run-Out Period, you will receive an annual statement that reflects the total amount contributed to and reimbursed from your account for the Plan Year.

In addition, the amount you contribute to DeCAP will be reflected on your Form W-2, which you receive from your employer. Your gross income for federal tax purposes will reflect the adjusted amount.


  • You must add back the amount listed as IRC 125 on your Form W-2 to your state/city gross wages.
  • You must also attach Form 2441 Child and Dependent Care Expenses to your Form 1040.

Learn more about your W-2 Wage and Tax Statement on the Office of Payroll Administration Web site 

Read the DeCAP FAQ 


Employee Assistance Programs (EAPs)
EAPs are staffed by professional counselors who can help employees and their eligible dependents handle problems in areas such as stress, alcoholism, drug abuse, mental health, and family difficulties.

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