Information Collection

CMS-10710. GenIC#13 - TRIPTK

IC 278279 under ICR 202609-0938-011 · OMB 0938-1382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home & Facility_Beneficiaries CMS-10710. GenIC#13 - TRIPTK	Form and Instruction
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home DYADs Caregivers and Beneficiaries CMS-10710. GenIC#13 - TRIPTK	Form and Instruction
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Beneficiaries.docx CMS-10710. GenIC#13 - TRIPTK	Form and Instruction
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Caregivers CMS-10710. GenIC#13 - TRIPTK	Form and Instruction
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_UX Task & Talk CMS-10710. GenIC#13 - TRIPTK	Form and Instruction
Form CMS-10710 CMS-10710.[Medicare Research GenIC#13-TRIPTK] Homework_Journey Map CMS-10710. GenIC#13 - TRIPTK	Form and Instruction
CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussio CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home & Facility_Beneficiaries.docx	Form and Instruction
CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussio CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home DYADs Caregivers and Beneficiaries.docx	Form and Instruction
CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussio CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Beneficiaries.docx	Form and Instruction
CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussio CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Caregivers.docx	Form and Instruction
CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussio CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_UX Task & Talk.docx	Form and Instruction
CMS-10710 CMS-10710.[Medicare Research GenIC#13-TRIPTK] Homework_J CMS-10710.[Medicare Research GenIC#13-TRIPTK] Homework_Journey Map.pdf	Form and Instruction
CMS-10710.[Medicare Research GenIC#13-TRIPTK] PRA Coversheet.docx CMS-10710.[Medicare Research GenIC#13-TRIPTK] PRA Coversheet	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

CMS-10710. GenIC#13 - TRIPTK

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10710	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10710	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10710	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10710	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10710	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10710	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 132

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	132	132
Annual IC Time Burden (Hours)	192	192
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10710.[Medicare Research GenIC#13-TRIPTK] PRA Coversheet		12/02/2025

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

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