NYS Flex Spending Account Enrollment Book Request

To order a NYS Flex Spending Account (FSA) enrollment book, which includes information for both the Dependent Care Advantage Account and the Health Care Spending Account, please enter your mailing information below.
  A * next to an item indicates that it is required.

Please select which plan year book(s) you would like to request.
2020 Enrollment Book  2019 Enrollment Book

Please enter your full name.
* First Name:
Middle Initial:
* Last Name:

Please enter your full address that the information materials should be mailed to.
* Address:
Address (Cont'd):
* City:
* State:
* 5 Digit Zip Code:
Zip Code 4 Digit Extension:

Andrew M. Cuomo, Governor