OMB control number
Health Reimbursement Arrangements and Other Account-Based Group Health Plans (CMS-10704)
OMB 0938-1361 · HHS/CMS.
OMB 0938-1361
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.
The latest form for Health Reimbursement Arrangements and Other Account-Based Group Health Plans (CMS-10704) expires 2026-11-30 and is listed under ICR 202306-0938-008.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10704 Health Reimbursement Arrangements | Form and Instruction |
 CMS-10704 HRA Supporting Statement 30df.docx | Supporting Statement A |
| CMS-10704 Appendix A - Comment Response Summary 30d.pdf | Supplementary Document |
 Health Reimbursement Arrangements |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202306-0938-008 | Revision of a currently approved collection | 2023-06-20 | Approved without change | |
| 201911-0938-012 | Extension without change of a currently approved collection | 2019-12-30 | Approved without change | |
| 201906-0938-005 | No material or nonsubstantive change to a currently approved collection | 2019-06-18 | Approved with change | |
| 201906-0938-002 | New collection (Request for a new OMB Control Number) | 2019-06-10 | Approved without change |