Information Collection

CMS-10710. GenIC#15 – TRIPTK- Journey AI Survey - Professionals

IC 278282 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#14-TRIPTK] JourneyAI Survey_Beneficiaries & Caregivers CMS-10710. GenIC#15 – TRIPTK- Journey AI Survey - Professionals	Form and Instruction
CMS-10710 CMS-10710.[Medicare Research GenIC#14-TRIPTK] JourneyAI CMS-10710.[Medicare Research GenIC#14-TRIPTK] JourneyAI Survey_Beneficiaries & Caregivers.docx	Form and Instruction
CMS-10710.[Medicare Research GenIC #15-TRIPTK] PRA Coversheet_JourneyAI Survey_Professionals.docx CMS-10710.[Medicare Research GenIC #15-TRIPTK] PRA Coversheet_JourneyAI Survey_Professionals	IC Document

IC Title:

CMS-10710. GenIC#15 â TRIPTK- Journey AI Survey - Professionals

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10710				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10710.[Medicare Research GenIC #15-TRIPTK] PRA Coversheet_JourneyAI Survey_Professionals		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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