Medicaid Statistical Information System (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⚠️ Notice: This information collection may be referencing outdated material.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
Feb2014-MSIS-DD - updated 25 April 2014.pdf Other-Data Dictionary

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Removed

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			Feb2014-MSIS-DD - updated 25 April 2014.pdf		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: 44	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-176	176
Annual IC Time Burden (Hours)	-1,760	1,760
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.