OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

IC 205266 under ICR 202206-0938-014 · OMB 0938-0345.

Documents and Forms
Document Name
Document Type
Other-Data Dictionary
Other-Data Dictionary
Other-Valid_Value_List
Other-Valid_Value_List
Other-Appendix
Other-Appendix
Other-Record_SegmentRelationships
Other-Record_SegmentRelationships
Other-T-MSIS Record Layouts V2.4.0
Other-T-MSIS Record Layouts V2.4.0
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Transformed - Medicaid Statistical Information System (T-MSIS)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Data Dictionary 1-T-MSIS_V2.4.0_DataDictionary.xlsx Yes No Fillable Fileable
Other-Valid_Value_List 2a-TMSIS_V2.4.0_Valid_Value_List.xlsx Yes No Fillable Fileable
Other-Appendix 2b-TMSIS_V2.4.0_Appendix.docx Yes No Fillable Fileable
Other-Record_SegmentRelationships 3-TMSIS_V2.4.0_Record_SegmentRelationships.docx Yes No Fillable Fileable
Other-T-MSIS Record Layouts V2.4.0 4 - T-MSIS Record Layouts V2.4.0.xlsx Yes No Fillable Fileable

Health Health Care Services

Medicaid Statistical Information System (MSIS)  71 FR 65527

54 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 648 0 0 -12 0 660
Annual IC Time Burden (Hours) 6,480 0 0 -120 0 6,600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.