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

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 2023-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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All Historical Document Collections

202306-0938-008 Approved without change	Revision of a currently approved collection	2023-06-20
201911-0938-012 Approved without change	Extension without change of a currently approved collection	2019-12-30
201906-0938-005 Approved with change	No material or nonsubstantive change to a currently approved collection	2019-06-18
201906-0938-002 Approved without change	New collection (Request for a new OMB Control Number)	2019-06-10