Information Collection Request
Health Reimbursement Arrangements and Other Account-Based Group Health Plans (CMS-10704)
ICR 202306-0938-008 · OMB 0938-1361 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 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 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 236410 |  Health Reimbursement Arrangements |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1361 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 201911-0938-012 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |