Patient Registration Data Fields

MHS GENESIS Patient Registration Module & Patient Portal

OMB: 0720-0064

IC ID: 237231

Information Collection (IC) Details

View Information Collection (IC)

Patient Registration Data Fields 0720-AHBJ
 
No New
 
Required to Obtain or Retain Benefits
 
32 CFR 199

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

Defense and National Security Operational Defense

 

2,870,338 0
   
Individuals or Households
 
   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 2,870,338 0 2,870,338 0 0 0
Annual IC Time Burden (Hours) 334,873 0 334,873 0 0 0
Annual IC Cost Burden (Dollars) 8,783,234 0 8,783,234 0 0 0

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

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