Form CMS-10433 Appendix B 4 ServiceArea Template

Service Area v2.6	Instructions:	All fields with an asterisk (*) are required
		Click Create Service Area IDs button to create service area ids based on your state
		Service Area IDs will populate in the drop-down box in Service Area ID column
HIOS Issuer ID:*
Issuer State:*
Service Area ID*	Service Area Name*	State*	County Name	Partial County
Required: Enter the Service Area ID	Required: Enter the Service Area Name	Required: Does this Service Area cover the entire state?	Required if State is "No": Select the County - FIPS this Service Area covers	Required if State is "No": Does this Service Area include a partial county?