Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

IC 205266 under ICR 202409-0938-023 · OMB 0938-0345.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0345 can be found here:

2026-06-15 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
T-MSIS Data Dictionary v4.0.0 508.xlsx	Other-Data Dictionary
T-MSIS Data Dictionary v4.0.0 508.xlsx	Other-Data Dictionary
T-MSIS Valid Value Lists v4.0.0 508.xlsx	Other-Valid_Value_List
T-MSIS Valid Value Lists v4.0.0 508.xlsx	Other-Valid_Value_List
T-MSIS Data Dictionary Appendices v4.0.0 508.pdf	Other-Appendix
T-MSIS Data Dictionary Appendices v4.0.0 508.pdf	Other-Appendix
T-MSIS Record Segment Definitions and Relationships v4.0.0 508.pdf	Other-Record_SegmentRelationships
T-MSIS Record Segment Definitions and Relationships v4.0.0 508.pdf	Other-Record_SegmentRelationships
T-MSIS Data Dictionary - v2.4.0 to v4.0.0 Redline.pdf Redline - Data Dictionary	IC Document
T-MSIS Data Dictionary - v2.4.0 to v4.0.0 Redline.pdf Redline - Data Dictionary	IC Document
T-MSIS Valid Valid List - v2.4.0 to v4.0.0 Redline.pdf Redline - Valid Value List	IC Document
T-MSIS Valid Valid List - v2.4.0 to v4.0.0 Redline.pdf Redline - Valid Value List	IC Document
T-MSIS Valid Value Lists Crosswalk v2.4.0 - v4.0.0 508.xlsx Crosswalk - Valid Value List	IC Document
T-MSIS Valid Value Lists Crosswalk v2.4.0 - v4.0.0 508.xlsx Crosswalk - Valid Value List	IC Document
T-MSIS Data Dictionary Appendices v2.4.0 - v4.0.0 Redline.pdf Redline - Data Dictionary Appendices	IC Document
T-MSIS Data Dictionary Appendices v2.4.0 - v4.0.0 Redline.pdf Redline - Data Dictionary Appendices	IC Document
T-MSIS Data Dictionary Crosswalk v2.4.0 - v4.0.0 508.xlsx Crosswalk - Data Dictionary	IC Document
T-MSIS Data Dictionary Crosswalk v2.4.0 - v4.0.0 508.xlsx Crosswalk - Data Dictionary	IC Document
T-MSIS Record Segment Definitions and Relationships v4.0.0 Redline.pdf Redline - File Segment Layout	IC Document
T-MSIS Record Segment Definitions and Relationships v4.0.0 Redline.pdf Redline - File Segment Layout	IC Document

Information Collection (IC) Details

View Information Collection (IC)

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	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

Federal Enterprise Architecture Business Reference Module

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	648	0	648
Annual IC Time Burden (Hours)	7,290	810	6,480
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.