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Agenda
Reg Review
ICR
View Information Collection (IC)
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
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Data Dictionary
1-T-MSIS_V2.4.0_DataDictionary.xlsx
Yes
No
Fillable Fileable
Other-Valid_Value_List
2a-TMSIS_V2.4.0_Valid_Value_List.xlsx
Yes
No
Fillable Fileable
Other-Appendix
2b-TMSIS_V2.4.0_Appendix.docx
Yes
No
Fillable Fileable
Other-Record_SegmentRelationships
3-TMSIS_V2.4.0_Record_SegmentRelationships.docx
Yes
No
Fillable Fileable
Other-T-MSIS Record Layouts V2.4.0
4 - T-MSIS Record Layouts V2.4.0.xlsx
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
648
0
0
-12
0
660
Annual IC Time Burden (Hours)
6,480
0
0
-120
0
6,600
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SHO Letter # 18-008
sho18008.pdf
05/31/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.