Transformed - Medicaid Statistical Information System (T-MSIS)

Transformed - Medicaid Statistical Information System (T-MSIS) (CMS-R-284)

⚠️ Notice: This information collection may be referencing outdated material.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
1-TMSIS_V2.1_DataDictionary (2019 version 2).xlsx Other-Data Dictionary
2-TMSIS_V2.1_Appendix.docx Other-Data Dictionary Appendices
4-TMSIS_V2.1_Record_Layouts (2019 version 2).xlsx Other-Record Layouts
5-TMSIS_V2.1_Validation_Rules (2019 version 2).xlsx Other-Validation Rules
3-TMSIS_V2.1_Record_SegmentRelationships (2019 version 2).docx Other-Record Segment Definitions
sho18008.pdf SHO Letter # 18-008 IC Document

Information Collection (IC) Details

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:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Dictionary	1-TMSIS_V2.1_DataDictionary (2019 version 2).xlsx	Yes	Yes	Fillable Fileable
Other-Data Dictionary Appendices	2-TMSIS_V2.1_Appendix.docx	Yes	Yes	Fillable Fileable
Other-Record Layouts	4-TMSIS_V2.1_Record_Layouts (2019 version 2).xlsx	Yes	Yes	Fillable Fileable
Other-Validation Rules	5-TMSIS_V2.1_Validation_Rules (2019 version 2).xlsx	Yes	Yes	Fillable Fileable
Other-Record Segment Definitions	3-TMSIS_V2.1_Record_SegmentRelationships (2019 version 2).docx	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: 55	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	660	48	612
Annual IC Time Burden (Hours)	6,600	480	6,120
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SHO Letter # 18-008	sho18008.pdf	05/31/2019

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