DoD Active Duty/Reserve Forces Dental Examination

Forms and Documents

Document Name	Status
Form DD Form 2813 DoD Active Duty/Reserve Forces Dental Examination Form	Modified
SSPA for 0720-0022 PASSBACK CHANGES ACCEPTED.doc Supporting Statement A	2016-11-28
SIGNED SSN memo.pdf Supplementary Document	2013-05-03

IC Document Collections

IC ID	Document Title	Status
43598	DoD Active Duty/Reserve Forces Dental Examination Form	Modified

ICR Details

OMB Control No: 0720-0022	ICR Reference No: 201608-0720-001
Status: Historical Active	Previous ICR Reference No: 201305-0720-001
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: DoD Active Duty/Reserve Forces Dental Examination
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/02/2016
	Date Received in OIRA: 08/31/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved	12/31/2016
Responses	750,000	0	712,500
Time Burden (Hours)	37,500	0	35,625
Cost Burden (Dollars)	621,450	0	0

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Abstract: The DoD must obtain the dental health status of members of the active and reserve components for deployment readiness. This form is designed to be completed by members' civilian dentists and provided to the members military organization for tracking dental health status. This form includes uses by active component members assigned to remote locations.

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Authorizing Statute(s): US Code: 10 USC 10206 Name of Law: Armed Forces Members: Physical Examinations
  

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:
	81 FR 23278	04/20/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 59611	08/30/2016
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
DoD Active Duty/Reserve Forces Dental Examination	DD Form 2813	Department of Defense Active Duty / Reserve / Guard / Civilian Forces Dental Examination

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ICR Summary 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	750,000	712,500	0	37,500	0	0
Annual Time Burden (Hours)	37,500	35,625	0	1,875	0	0
Annual Cost Burden (Dollars)	621,450	0	0	621,450	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 small increase in respondents and burden hours is due to an increase of remote service members. The number of respondents is not a static number and is dependent on the physical location of troops at the time and mission orientation.

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Annual Cost to Federal Government: $43,500

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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? Uncollected

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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: 08/31/2016

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