Patient Registration Data Fields

MHS GENESIS Patient Registration Module & Patient Portal

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0064 can be found here:

Documents and Forms

Document Name Document Type
MHS GENESIS Patient Registration _00104 ver2.pdf patientportal.mhsgenesis.health.mil/ Other-Screenshots
PASanADN.pdf patientportal.mhsgenesis.health.mil/privacy Other-PAS & ADN

Information Collection (IC) Details

IC Title:	Patient Registration Data Fields	Agency IC Tracking Number:	0720-AHBJ

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 199

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots			MHS GENESIS Patient Registration _00104 ver2.pdf	patientportal.mhsgenesis.health.mil/	Yes	Yes	Fillable Fileable
Other-PAS & ADN			PASanADN.pdf	patientportal.mhsgenesis.health.mil/privacy	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,870,338	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,870,338	2,870,338
Annual IC Time Burden (Hours)	334,873	334,873
Annual IC Cost Burden (Dollars)	8,783,234	8,783,234

Documents for IC

Title	Document	Date Uploaded
No associated records found

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