Information Collection

GenIC#14 – TRIPTK- Journey AI Surveys Beneficiaries and Caregivers

IC 278379 under ICR 202402-0938-008 · OMB 0938-1382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10710.GenIC#14 GenIC#14-TRIPTK - JourneyAI Survey_Beneficiaries & Caregivers.docx GenIC#14 – TRIPTK- Journey AI Surveys Beneficiaries and Caregivers	Form and Instruction
CMS-10710.GenIC#14 GenIC#14-TRIPTK - JourneyAI Survey_Beneficiaries & Careg CMS-10710.[Medicare Research GenIC#14-TRIPTK] JourneyAI Survey_Beneficiaries & Caregivers.docx	Form and Instruction
CMS-10710. [Medicare Research GenIC#14-TRIPTK] Coversheet_JourneyAI Survey_Beneficiaries & Caregivers.docx CMS-10710. [Medicare Research GenIC#14-TRIPTK] Coversheet_JourneyAI Survey_Beneficiaries & Caregivers	IC Document

IC Title:

GenIC#14 â TRIPTK- Journey AI Surveys Beneficiaries and Caregivers

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10710.GenIC#14				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	366	366
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10710. [Medicare Research GenIC#14-TRIPTK] Coversheet_JourneyAI Survey_Beneficiaries & Caregivers		12/09/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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