Health Reimbursement Arrangements and Other Account-Based Group Health Plans (CMS-10704)

ICR 202306-0938-008

OMB: 0938-1361

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10704 Health Reimbursement Arrangements Form and Instruction	Modified
CMS-10704 HRA Supporting Statement 30df.docx Supporting Statement A	2023-06-20
CMS-10704 Appendix A - Comment Response Summary 30d.pdf Supplementary Document	2019-11-22

IC Document Collections

IC ID	Document Title	Status
236410	Health Reimbursement Arrangements Form and Instruction	Modified