Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

IC 205266 under ICR 202206-0938-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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_V2.4.0_DataDictionary.xlsx	Other-Data Dictionary
1-T-MSIS_V2.4.0_DataDictionary.xlsx	Other-Data Dictionary
2a-TMSIS_V2.4.0_Valid_Value_List.xlsx	Other-Valid_Value_List
2a-TMSIS_V2.4.0_Valid_Value_List.xlsx	Other-Valid_Value_List
2b-TMSIS_V2.4.0_Appendix.docx	Other-Appendix
2b-TMSIS_V2.4.0_Appendix.docx	Other-Appendix
3-TMSIS_V2.4.0_Record_SegmentRelationships.docx	Other-Record_SegmentRelationships
3-TMSIS_V2.4.0_Record_SegmentRelationships.docx	Other-Record_SegmentRelationships
4 - T-MSIS Record Layouts V2.4.0.xlsx	Other-T-MSIS Record Layouts V2.4.0
4 - T-MSIS Record Layouts V2.4.0.xlsx	Other-T-MSIS Record Layouts V2.4.0
sho18008.pdf SHO Letter # 18-008	IC Document
sho18008.pdf SHO Letter # 18-008	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_V2.4.0_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

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: 54

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

Documents for IC

table that charts IC Documents
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.