Information Collection

Transformed - Medicaid Statistical Information System (T-MSIS)

IC 205266 under ICR 202610-0938-005 · OMB 0938-0345.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
T-MSIS Data Dictionary - v4.1.1.pdf	Other-Data Dictionary
T-MSIS Valid Value Lists - v4.1.1.pdf	Other-Valid_Value_List
T-MSIS Data Dictionary - v4.1.1.pdf	Other-Appendix
T-MSIS Record Segment Definitions and Relationships v4.1.1.pdf	Instruction
T-MSIS Data Dictionary - v4.0.0 to v4.1.1 Redline.pdf Redline - Data Dictionary	IC Document
T-MSIS Valid Value Lists - v4.0.0 to v4.1.1 Redline.pdf Redline - Valid Value List	IC Document
T-MSIS Valid Value List Crosswalk v4.0.0 to v4.1.1.pdf Crosswalk - Valid Value List	IC Document
T-MSIS Data Dictionary Crosswalk v4.0.0 to v4.1.1.pdf Crosswalk - Data Dictionary	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
Instruction	Yes	Yes	Printable Only

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

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

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