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TRICARE Dental Program (TDP) Claim Form
TRICARE Dental Program (TDP) Claim Form
OMB: 0720-0035
IC ID: 5616
OMB.report
DOD/DODOASHA
OMB 0720-0035
ICR 200511-0720-001
IC 5616
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0035 can be found here:
2009-11-13 - Reinstatement without change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
TRICARE Dental Program (TDP) Claim Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
56,512
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
35 %
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
3,503,744
0
0
0
0
3,503,744
Annual IC Time Burden (Hours)
875,936
0
0
0
0
875,936
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.