Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

IC 205014 under ICR 201212-0938-001 · OMB 0938-0345.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0345 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
T-MSIS_Data_Dictionary_[rev_11-29-2012_by_OSORA_PRA].docx	Other-Data Dictionary
Data_Element_Lists_2012-Dec_and_2012-Feb_as_of_2012-11-12.xlsx Data Elements List	IC Document

IC Title:

Transformed - Medicaid Statistical Information System (T-MSIS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Other-Data Dictionary			T-MSIS_Data_Dictionary_[rev_11-29-2012_by_OSORA_PRA].docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Medicaid Statistical Information System (MSIS)

FR Citation: 77 FR 65527

Number of Respondents: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	612	612
Annual IC Time Burden (Hours)	6,120	6,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Data Elements List	Data_Element_Lists_2012-Dec_and_2012-Feb_as_of_2012-11-12.xlsx	12/03/2012

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