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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10704 Model Attestation	Form and Instruction	Modified	Available
Form CMS-10704 Model Notice	Form and Instruction	Modified	Available
Form CMS-10704 Health Reimbursement Arrangements	Form and Instruction	Modified	Repair queued
CMS-10704 HRA Supporting Statement 30df.docx	Supporting Statement A	Uploaded 2023-06-20	Repair queued
CMS-10704 Appendix A - Comment Response Summary 30d.pdf	Supplementary Document	Uploaded 2019-11-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
236410	Health Reimbursement Arrangements	Form and Instruction	Modified	Model Attestation
236410	Health Reimbursement Arrangements	Form and Instruction	Modified	Model Notice
236410	Health Reimbursement Arrangements	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1361	ICR Reference No: 202306-0938-008
Status: Active	Previous ICR Reference No: 201911-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Health Reimbursement Arrangements and Other Account-Based Group Health Plans (CMS-10704)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/15/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/20/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	36 Months From Approved	11/30/2023
Responses	849,442	0	272,680
Time Burden (Hours)	5,890	0	6,016
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection requirements in the final rule is in response to Executive Order 13813, "Promoting Healthcare Choice and Competition Across the United States." It responds to comments on a proposal to adjust the usability of HRAs to expand employers' ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2711 Name of Law: No lifetime or annual limits.
   PL: Pub.L. 104 - 191 2870 Name of Law: HIPAA nondiscrimination provisions
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2711 Name of Law: No lifetime or annual limits.
PL: Pub.L. 104 - 191 2870 Name of Law: HIPAA nondiscrimination provisions

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 7976	02/07/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 29133	05/05/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Health Reimbursement Arrangements	CMS-10704, CMS-10704	Model Notice ,   Model Attestation

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	849,442	272,680	-5,485	0	582,247	0
Annual Time Burden (Hours)	5,890	6,016	68	0	-194	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: For data collections related to ICHRAs, the total burden for the 3 years decreased to 17,465 hours from 18,049 hours, a total reduction of 584 hours. The decrease in burden is due to a change in the estimated number of employers offering ICHRAs for the first time (from 6,016 employers in total over 3 years to 5,822 employers in total over 3 years). A new annual burden of 68 hours for the data collections related to EBHRAs (previously included in the information collection approved under OMB Control Number 0938-1375) has been included in this information collection. For the data collections related to EBHRAs, the total burden for the 3 years decreased to 203 hours from 1,487 hours, a total reduction of 1,284 hours. The decrease in burden is due to the assumption that the burden associated with the initial notice preparation has already been incurred in 2020. As discussed above, CMS will request to discontinue OMB Control Number 0938-1375 as the EBHRA requirements have been merged into this ICR.

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Annual Cost to Federal Government: $1,395

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/20/2023

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