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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.