OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

IC 205266 under ICR 202409-0938-023 · 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
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
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 T-MSIS Data Dictionary v4.0.0 508.xlsx Yes No Fillable Fileable
Other-Valid_Value_List T-MSIS Valid Value Lists v4.0.0 508.xlsx Yes No Fillable Fileable
Other-Appendix T-MSIS Data Dictionary Appendices v4.0.0 508.pdf Yes No Fillable Fileable
Other-Record_SegmentRelationships T-MSIS Record Segment Definitions and Relationships v4.0.0 508.pdf 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 0 0 648
Annual IC Time Burden (Hours) 7,290 0 810 0 0 6,480
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Redline - Data Dictionary T-MSIS Data Dictionary - v2.4.0 to v4.0.0 Redline.pdf 09/20/2024
Redline - Valid Value List T-MSIS Valid Valid List - v2.4.0 to v4.0.0 Redline.pdf 09/20/2024
Crosswalk - Valid Value List T-MSIS Valid Value Lists Crosswalk v2.4.0 - v4.0.0 508.xlsx 09/20/2024
Redline - Data Dictionary Appendices T-MSIS Data Dictionary Appendices v2.4.0 - v4.0.0 Redline.pdf 09/20/2024
Crosswalk - Data Dictionary T-MSIS Data Dictionary Crosswalk v2.4.0 - v4.0.0 508.xlsx 09/20/2024
Redline - File Segment Layout T-MSIS Record Segment Definitions and Relationships v4.0.0 Redline.pdf 09/20/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.