NYC FSA Claim Form: HCFSA and DeCAP Filing and Deadlines

NYC municipal employees get reimbursed from their Flexible Spending Account by completing the correct claim form from the Office of Labor Relations, attaching itemized proof of each expense, and submitting the package through the city’s upload portal at nyc-fsa.leapfile.net. There are two separate NYC FSA claim forms, one for the Health Care Flexible Spending Account (HCFSA) and one for the Dependent Care Assistance Program (DeCAP), and they are not interchangeable. Both live on the FSA Forms and Downloads page.¹

Pick the Right Form First

Use the HCFSA claim form for your own and your dependents’ out-of-pocket medical, dental, vision, and other qualifying health expenses. Use the DeCAP claim form for dependent care expenses like daycare or after-school care that let you (and your spouse, if applicable) work. If you have both accounts, you’ll file separately for each. Mixing expenses on the wrong form will get the claim kicked back.

Filling Out the HCFSA Form

The top of the form asks for your last name, first name, middle initial, and the last four digits of your Social Security number.² You also fill in home address, email, daytime phone, work phone, and your agency name. Enter the agency, not the division within it. If your address has changed since you enrolled, check the box for new addresses so your records update at the same time.

The expense grid is where most mistakes happen. For each line, enter the provider’s name, the patient’s name (you or a covered dependent), the actual date of service, the type of service, and the amount you’re claiming. Each line needs to match a specific receipt or Explanation of Benefits in your attachments. Don’t lump multiple visits or dates onto a single row. List them separately so the reviewer can tie each line to a document.

Filling Out the DeCAP Form

DeCAP collects the same personal information at the top, but the provider section works differently. Your dependent care provider has to sign the form and give their name, address, and either their Federal Tax Identification Number or Social Security Number.³ Without the tax ID, the claim won’t be processed. If you can’t get the provider to sign the form itself, an attached itemized statement from the provider with the same details (name, address, tax ID, dates of service, and amounts) is accepted in place of the signature.

Have the tax ID in hand before you sit down to fill the form out. This is the most common thing people are missing when a DeCAP claim gets delayed.

What You Have to Attach

A claim form with no backup gets denied. What qualifies as backup depends on whether insurance was involved.

If insurance paid part of the expense, attach the Explanation of Benefits from your carrier. The EOB shows the total charge, what insurance paid, and your patient responsibility. Claim only the patient responsibility amount.
If no insurance was involved, attach an itemized receipt from the provider showing the patient’s name, date of service, description of the service, provider’s name, and the amount charged.⁴
A credit card slip showing only a dollar amount, a balance-forward statement, or a canceled check will not work. They prove you paid something but not what you paid for.

Be specific in the description. “Office visit” is often too vague. Write what the service actually was: physical therapy, dental cleaning, eye exam. The reviewer has to confirm it qualifies under IRS rules, and a specific description makes that quick.

For orthodontia on an installment plan, submit a copy of the payment contract (provider name, patient name, description of service, payment schedule, payment amount) instead of chasing an invoice each month. After that, a monthly payment receipt or coupon from the orthodontist paired with the contract on file is enough for subsequent installments.

How to Submit

Three methods are available. The city clearly prefers electronic upload — it’s listed first on every instruction page and gives you an instant confirmation.

Electronic upload: go to nyc-fsa.leapfile.net and upload the completed form with every supporting document. You’ll see a “Success! Your file has been received” message immediately. That on-screen message is your proof of submission; no follow-up email is sent. Don’t upload the same claim twice; duplicates slow processing.¹
Regular mail: The Flexible Spending Accounts Program, P.O. Box 707, Bowling Green Station, New York, NY 10274. Use a trackable mailing method.
Express or overnight only: NYC Flexible Spending Accounts Program, 22 Cortlandt Street, 28th Floor, New York, NY 10007. Don’t send regular mail here; it may not be received.

Questions before you submit go to the FSA Administrative Office at (212) 306-7760 or (212) 306-7789, Monday through Friday, 9:00 a.m. to 4:00 p.m.¹

When You’ll Get Paid

Claims are processed on a monthly cycle. If your claim reaches the FSA Administrative Office by the 25th of the month, it’s processed that month and reimbursement is deposited by the end of the following month.⁵ A claim received March 20 is processed in March and paid by the end of April. A claim received March 27 misses the cutoff, gets processed in April, and pays by the end of May. Submitting a few days earlier can shave a full month off your wait.

Payment goes by direct deposit to the account you designated on your FSA Enrollment/Change Form unless you’re still set up for paper checks.

Deadlines You Can’t Miss

The HCFSA and DeCAP deadlines are different, and mixing them up is an easy way to forfeit money.

HCFSA

The HCFSA has a grace period: you can incur new eligible expenses from January 1 through March 15 of the following year and apply them against the prior plan year’s balance.⁶ A run-out period then lets you submit paperwork for anything incurred during the plan year or grace period. The run-out closes May 31. After that, claims are denied regardless of whether the expense was valid.⁷

DeCAP

DeCAP has no grace period. Expenses have to be incurred within the plan year itself, January 1 through December 31. The run-out window is also shorter: for the 2025 plan year the submission deadline is February 28, 2026, and for the 2026 plan year it’s February 28, 2027.⁸

Forfeiture

Anything left in either account after its run-out period is forfeited under IRS rules.⁷ You don’t get it back. File claims as expenses come in rather than letting receipts accumulate toward a single late-season submission.

1
NYC Office of Labor Relations. FSA Forms and Downloads
2
City of New York. Health Care Flexible Spending Account (HCFSA) Program – NYC FSA Claim Form
3
NYC Office of Labor Relations. NYC Dependent Care Assistance Program Claim Form
4
City University of New York. Health Care Flexible Spending Account (HCFSA) Program Claims Form
5
City University of New York. 2024 New York City Flexible Spending Accounts Program
6
NYC Office of Labor Relations. HCFSA Procedures Guide
7
Office of Labor Relations. Health Care Flexible Spending Account Program
8
Office of Labor Relations. Dependent Care Assistance Program