Information Collection

Medicaid Statistical Information System (MSIS)

IC 7980 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⚠️ Notice: This information collection may be referencing outdated material.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
msisdd7-2010.pdf Other-Data Dictionary
smm2700-p1-4-updated2009.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicaid Statistical Information System (MSIS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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			msisdd7-2010.pdf		Yes	No	Printable Only
Instruction			smm2700-p1-4-updated2009.doc		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: 71 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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	204	204
Annual IC Time Burden (Hours)	2,040	2,040
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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