Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

IC 205266 under ICR 201604-0938-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
1 - T-MSIS V2_0 Data Dictionary - 2015-11-24.xlsx	Other-Data Dictionary
2 - T-MSIS V2_0 Data Dictionary Appendices - 2015-11-24.docx	Other-Data Dictionary Appendices
3 - T-MSIS V2_0 Record Layouts - 2015-11-24.xlsx	Other-Record Layouts
4 - T-MSIS V2_0 Validation Rules - 2015-11-24.xlsx	Other-Validation Rules
5 - T-MSIS V1_1 to V2_0 DD Comparison - 2015-11-24.xlsx Crosswalk - Data Dictionaries	IC Document
6 - T-MSIS V1_1 to V2_0 Record Layout Comparison - 2015-11-24.xlsx Crosswalk - Record Layout	IC Document
7 - T-MSIS V1_1 to V2_0 Validation Rules Comparison- 2015-11-24.xlsx Crosswalk - Validation Rules	IC Document
8 - T-MSIS Change Request Log - 2015-11-24.xlsx Change Request Log	IC Document

IC Title:

Transformed - Medicaid Statistical Information System (T-MSIS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Dictionary	1 - T-MSIS V2_0 Data Dictionary - 2015-11-24.xlsx	Yes	Yes	Fillable Fileable
Other-Data Dictionary Appendices	2 - T-MSIS V2_0 Data Dictionary Appendices - 2015-11-24.docx	Yes	Yes	Fillable Fileable
Other-Record Layouts	3 - T-MSIS V2_0 Record Layouts - 2015-11-24.xlsx	Yes	Yes	Fillable Fileable
Other-Validation Rules	4 - T-MSIS V2_0 Validation Rules - 2015-11-24.xlsx	Yes	Yes	Fillable Fileable

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 %

table that charts list of burden
	Approved	Previously Approved
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
Crosswalk - Data Dictionaries	5 - T-MSIS V1_1 to V2_0 DD Comparison - 2015-11-24.xlsx	04/15/2016
Crosswalk - Record Layout	6 - T-MSIS V1_1 to V2_0 Record Layout Comparison - 2015-11-24.xlsx	04/15/2016
Crosswalk - Validation Rules	7 - T-MSIS V1_1 to V2_0 Validation Rules Comparison- 2015-11-24.xlsx	04/15/2016
Change Request Log	8 - T-MSIS Change Request Log - 2015-11-24.xlsx	04/15/2016

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