Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

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

Documents and Forms

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

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:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Dictionary	T-MSIS Data Dictionary v4.1.0 51526_v2.xlsx	Yes	No	Fillable Fileable
Other-Valid_Value_List	T-MSIS Valid Value Lists v4.1.0 051526_v2.xlsx	Yes	No	Fillable Fileable
Other-Appendix	T-MSIS Data Dictionary Appendices v2.4.0 - v4.0.0 Redline.pdf	Yes	No	Fillable Fileable
Other-Record_SegmentRelationships	T-MSIS Record Segment Definitions and Relationships v4.1.0 051526_v2.docx	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 %

	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

Title	Document	Date Uploaded
Redline - Data Dictionary	T-MSIS Data Dictionary - v4.0.0 to v4.1.0 Redline 051526_V2.docx	06/15/2026
Redline - Valid Value List	T-MSIS Valid Value Lists - v4.0.0 to v4.1.0 Redline 051526_v2.docx	06/15/2026
Crosswalk - Valid Value List	T-MSIS Valid Value Lists Crosswalk v4.0.0 to v4.1.0 05152026_v2.xlsx	06/15/2026
Redline - Data Dictionary Appendices	T-MSIS Data Dictionary Appendices v2.4.0 - v4.0.0 Redline.pdf	06/15/2026
Crosswalk - Data Dictionary	T-MSIS Data Dictionary Crosswalk v4.0.0 to v4.1.0 051526_v2.xlsx	06/15/2026
Redline - File Segment Layout	T-MSIS Record Segment Definitions and Relationships v4.0.0 to v4.1.0 Redline 051526_v2.docx	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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