Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

IC 205266 under ICR 202606-0938-012 · OMB 0938-0345.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
T-MSIS Data Dictionary v4.1.0 51526_v2.xlsx	Other-Data Dictionary
T-MSIS Valid Value Lists v4.1.0 051526_v2.xlsx	Other-Valid_Value_List
T-MSIS Data Dictionary Appendices v2.4.0 - v4.0.0 Redline.pdf	Other-Appendix
T-MSIS Record Segment Definitions and Relationships v4.1.0 051526_v2.docx	Other-Record_SegmentRelationships
T-MSIS Data Dictionary - v4.0.0 to v4.1.0 Redline 051526_V2.docx Redline - Data Dictionary	IC Document
T-MSIS Valid Value Lists - v4.0.0 to v4.1.0 Redline 051526_v2.docx Redline - Valid Value List	IC Document
T-MSIS Valid Value Lists Crosswalk v4.0.0 to v4.1.0 05152026_v2.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 Crosswalk v4.0.0 to v4.1.0 051526_v2.xlsx Crosswalk - Data Dictionary	IC Document
T-MSIS Record Segment Definitions and Relationships v4.0.0 to v4.1.0 Redline 051526_v2.docx Redline - File Segment Layout	IC Document

IC Title:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Dictionary	Yes	No	Fillable Fileable
Other-Valid_Value_List	Yes	No	Fillable Fileable
Other-Appendix	Yes	No	Fillable Fileable
Other-Record_SegmentRelationships	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
	Requested	Previously Approved
Annual Number of Responses for this IC	648	648
Annual IC Time Burden (Hours)	7,290	7,290
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Redline - Data Dictionary		06/15/2026
Redline - Valid Value List		06/15/2026
Crosswalk - Valid Value List		06/15/2026
Redline - Data Dictionary Appendices		06/15/2026
Crosswalk - Data Dictionary		06/15/2026
Redline - File Segment Layout		06/15/2026

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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