MHS GENESIS Patient Registration Module & Patient Portal

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0720-0064_SS-A_11.26.2025.docx	Supporting Statement A	Uploaded 2025-11-26	Available
0720-0064_SS-A_11.26.2025.docx	Supporting Statement A	Uploaded 2025-11-26	Repair queued
MHS GENESIS Electronic Health Record PIA_ 10.8.2024.pdf	Supplementary Document	Uploaded 2025-11-19	Available
MHS GENESIS Electronic Health Record PIA_ 10.8.2024.pdf	Supplementary Document	Uploaded 2025-11-19	Missing upstream
MHS GENESIS EHR (eID3202+Sub eIDS)_SSNJ_Memo_CPO_Approved.pdf	Supplementary Document	Uploaded 2025-11-19	Available
MHS GENESIS EHR (eID3202+Sub eIDS)_SSNJ_Memo_CPO_Approved.pdf	Supplementary Document	Uploaded 2025-11-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
237231	Patient Registration Data Fields	Other-Screenshots	Modified

ICR Details

OMB Control No: 0720-0064	ICR Reference No: 202511-0720-003
Status: Active	Previous ICR Reference No: 202208-0720-002
Agency/Subagency: DOD/DODOASHA	Agency Tracking No: 0720-0064
Title: MHS GENESIS Patient Registration Module & Patient Portal
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/12/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/26/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2029	36 Months From Approved	01/31/2026
Responses	3,000,000	0	2,870,338
Time Burden (Hours)	351,000	0	334,873
Cost Burden (Dollars)	11,431,000	0	10,361,920

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Abstract: The information collection requirement is necessary to provide and document medical care; determine eligibility for benefits and entitlements; adjudicate claims; determine whether a third party is responsible for the cost of MHS provided healthcare and recover that cost; and evaluate fitness for duty and medical concerns which may have resulted from an occupational or environmental hazard. Obtaining this information is essential for DoD providing medical care and recovering costs.

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Authorizing Statute(s): US Code: 42 USC 32 Name of Law: Third Party Liability for Hospital and Medical Care
   US Code: 10 USC 8111 Name of Law: Sharing of Department of VA and DoD Healthcare Resources
   US Code: 10 USC 1104 Name of Law: Sharing of Healthcare Resources with the Department of Veterans Affairs
   US Code: 10 USC 55 Name of Law: Medical and Dental Care
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 34252	07/21/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 54311	11/26/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Patient Registration Data Fields

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,000,000	2,870,338	0	129,662	0	0
Annual Time Burden (Hours)	351,000	334,873	0	16,127	0	0
Annual Cost Burden (Dollars)	11,431,000	10,361,920	0	1,069,080	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden has increased since the previous approval due to a slight increase in respondents.

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Annual Cost to Federal Government: $60,598,920

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/26/2025

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