Health Reimbursement Arrangements

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

OMB: 0938-1361

IC ID: 236410

Documents and Forms

Document Name Document Type
Form CMS-10704 Health Reimbursement Arrangements Form and Instruction
CMS-10704 Model Notice CMS-10704 - HRA Model Notice.pdf Form and Instruction
CMS-10704 Model Attestation CMS-10704 Attachment HRA Model Attestation.pdf Form and Instruction