[Medicaid] Transformed - Medicaid Statistical Information System (T-MSIS) (CMS-R-284)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-R-284 - Supporting Statement A (71109 version 7).docx	Supporting Statement A	Uploaded 2026-10-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
283155	Update the Valid Value Set for a Single Data Element (Section 71109 [Alien Eligibility] of the WFTC Legislation)		New
280953	Collection of Community Engagement Data (Section 71119 of the WFTC Legislation)		Unchanged
205266	Transformed - Medicaid Statistical Information System (T-MSIS)	Other-Data Dictionary	Modified

ICR Details

OMB Control No: 0938-0345	ICR Reference No: 202610-0938-005
Status: Received in OIRA	Previous ICR Reference No: 202606-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: [Medicaid] Transformed - Medicaid Statistical Information System (T-MSIS) (CMS-R-284)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/20/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2027
Responses	746	692
Time Burden (Hours)	37,390	29,290
Cost Burden (Dollars)	0	0

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Abstract: State data are reported by the federally mandated electronic process, known as MSIS is currently collecting eligibility and claim data in 5 separate files. These data are the basis of actuarial forecasts for Medicaid service utilization and costs; of analysis and cost savings estimates required for legislative initiatives relating to Medicaid and for responding to requests for information from CMS components, the Department, Congress and other customers. The expanded version of MSIS is now referred to as TMSIS will incorporate 3 additional files (Provider, Managed Care Plans, and Third Party Liability).

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Authorizing Statute(s): PL: Pub.L. 108 - 173 103 Name of Law: MMA
   US Code: 42 USC 1935 Name of Law: Medicare Prescription Drugs
   PL: Pub.L. 114 - 148 6504 Name of Law: ACA
   US Code: 42 USC 1396b(r) Name of Law: MMIS
   US Code: 42 USC 1301 Name of Law: HIPAA Law
   PL: Pub.L. 119 - 21 71119 Name of Law: Working Families Tax Cut (WFTC) legislation
   PL: Pub.L. 105 - 32 4753 Name of Law: BBA
   PL: Pub.L. 119 - 21 71109 Name of Law: Working Families Tax Cut (WFTC) legislation
  

Citations for New Statutory Requirements: US Code: 45 USC 3434 Name of Law: HIPAA
PL: Pub.L. 119 - 21 71109 Name of Law: Working Families Tax Cut (WFTC) legislation

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 45818	07/21/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 64153	10/07/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Collection of Community Engagement Data (Section 71119 of the WFTC Legislation)
Transformed - Medicaid Statistical Information System (T-MSIS)
Update the Valid Value Set for a Single Data Element (Section 71109 [Alien Eligibility] of the WFTC Legislation)

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	746	692	0	54	0	0
Annual Time Burden (Hours)	37,390	29,290	0	8,100	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This iteration proposes to add 8,100 hours of burden to comply with section 71109 (Alien Eligibility) of the WFTC legislation which limits FFP for full Medicaid and CHIP benefits, beginning October 1, 2026, to U.S. citizens and U.S. nationals, LPRs, Cuban/Haitian entrants, and COFA migrants. .

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Annual Cost to Federal Government: $18,500,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/20/2026

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