Flexible Spending Accounts

Important Notice

Please submit your forms and documents as follows:

1) Inquiries and questions can be sent via email to the Program.

2) Forms and documents can be submitted electronically to: https://nyc-fsa.leapfile.net

Please do not submit your form/document more than once.  This will only delay processing.

You will immediately receive notification stating "Success! Your file has been received" upon completion of your document upload.  You will not receive a separate email confirmation.

View step-by-step instructions and video

3) Mail completed forms/documents to:
The Flexible Spending Accounts Program
P.O. Box 707
Bowling Green Station
New York, NY 10274

4) Express mail forms/documents should be sent to:
NYC Flexible Spending Accounts Program
22 Cortlandt Street, 28th Floor
New York, NY 10007

Please check back periodically for updates

IMPORTANT - If you are currently receiving your reimbursement via check, please complete a Direct Deposit Form in order to receive reimbursement in a timely fashion.  Do not mail your completed form to the address on the form. Please submit your completed form following the directions above.

Download Adobe Scan to convert your hardcopy documents into PDFs. Use your smart phone or tablet camera to take a picture of your paper form and Adobe Scan will convert it to a PDF. Adobe Scan mobile app is available for iPhone and Android.

FSA Program Guides, Brochures & Forms

Brochures and Enrollment/Change Forms

Plan Year 2024

Procedures Guide

Plan Year 2024

FSA Claims Forms

Please direct all inquiries/correspondence and claims as follows:
1) Inquiries and questions can be sent via email to the Program.
2) Forms/documents can be submitted electronically to: https://nyc-fsa.leapfile.net

Plan Year 2024

Plan Year 2023

Lost Check Claim

To submit a claim for a lost check from the Management Benefits Fund, the Dependent Care Assistance Program, or the Health Care Flexible Spending Account Program.