Patient Registration Data Fields

MHS GENESIS Patient Registration Module & Patient Portal

Documents and Forms

Document Name Document Type
MHS GENESIS Patient Registration Screenshots_ 10.27.22.pdf patientportal.mhsgenesis.health.mil/ Other-Screenshots
MHS GENESIS Patient Registration Screenshots_ 10.27.22.pdf patientportal.mhsgenesis.health.mil/ Other-Screenshots

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

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 Screenshots_ 10.27.22.pdf	patientportal.mhsgenesis.health.mil/	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	Previously Approved
Annual Number of Responses for this IC	2,870,338	0	2,870,338
Annual IC Time Burden (Hours)	334,873	0	334,873
Annual IC Cost Burden (Dollars)	10,361,920	1,578,686	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.