Information Collection

Patient Registration Data Fields

IC 237231 under ICR 202511-0720-003 · OMB 0720-0064.

Documents and Forms

Document Name Document Type
MHS GENESIS Patient Registration Screenshots_ 11.26.25.pdf Other-Screenshots
MHS GENESIS Patient Registration Screenshots_ 11.26.25.pdf Other-Screenshots

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Patient Registration Data Fields	Agency IC Tracking Number:	0720-0064

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_ 11.26.25.pdf		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: 3,000,000	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	3,000,000	129,662	2,870,338
Annual IC Time Burden (Hours)	351,000	16,127	334,873
Annual IC Cost Burden (Dollars)	11,431,000	1,069,080	10,361,920

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.

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