Minnesota Cancer Surveillance System
Transmittal Form for Electronic Submission of Cases
Facility Information
Date:
Registry Name:
ACOS #:
MCSS #:N
Name of person preparing file:
File Name:
Example: 20140601.5023.newcases
File Information
Record layout format:
 NAACCR Version 15.___
 NAACCR Version 14.___
 NAACCR Version 13.___
 Other: _________________________
Approximate Range of Diagnosis Dates:
Software VENDOR:
Type of submission:
 ROUTINE monthly submission
 CLEANUP year submission
 MCSS REQUESTED submission
 OTHER
________________________________________
________________________________________
Software version:
Has your state reporting software been modified
since the last submission to the MCSS?
 NO
 YES Explain: ______________
Update/Correction Records Included?
 YES
 NO
Total number of records submitted: ___________cases
If number of records is greater than 500, please document reason for major submission:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
MCSS Tracking – Internal Use
Date received:
__________
__________
File name:
__________
__________
Total reportable:
__________
__________
Lognumber range:
__________
__________
July 14, 2015
Updates:
Duplicates:
Pre-88:
Non-MN:
Pre-12 Clinicals:
Benign:
Skin:
CIN III:
NR/dxyear:
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
Instructions for Transmittal Form for Electronic Submission of Cases
1. In the Facility Information area, complete Date, Registry Name, ACOS #, MCSS # and Name of
Person Preparing File. If you don’t know your MCSS #, please contact your Field Service
Representative at 651-201-5900.
2. Enter the File Name. Use this file naming convention: date file was created, your MCSS # and a
description of contents (e.g. “newcases” or “updates,” or “01” ), etc.
Examples: If you were preparing your file on June 1, 2015, and if your MCSS facility number were
5023, you would name your file like this: 20150601.5023.newcases or 20150601.5023.01.
3. Complete ALL boxes in the File Information section including: NAACCR version information, (e.g.
14.1). If using Other, please give specifics of name and version number.
4. Complete range of diagnosis dates box (e.g: July – Sept 2015).
5. Check appropriate box to notify if update/correction records are included.
6. Complete section on software vendor, version and any software modification information.
7. Complete box for type of submission.
8. Enter total number of records submitted. If there are more than 500 records, please provide an
explanation why.
July 14, 2015