DoD Active Duty/Reserve Forces Dental Examination

ICR 201912-0720-002

OMB: 0720-0022

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2019-12-20
Supporting Statement A
2019-12-20
IC Document Collections
IC ID
Document
Title
Status
43598 Modified
ICR Details
0720-0022 201912-0720-002
Active 201608-0720-001
DOD/DODOASHA
DoD Active Duty/Reserve Forces Dental Examination
Revision of a currently approved collection   No
Regular
Approved without change 01/28/2020
Retrieve Notice of Action (NOA) 12/20/2019
  Inventory as of this Action Requested Previously Approved
01/31/2023 36 Months From Approved 01/31/2020
750,000 0 750,000
37,500 0 37,500
621,450 0 621,450

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.

US Code: 10 USC 10206 Name of Law: Armed Forces Members: Physical Examinations
  
None

Not associated with rulemaking

  84 FR 44291 08/23/2019
84 FR 69728 12/19/2019
No

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

  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 750,000 750,000 0 0 0 0
Annual Time Burden (Hours) 37,500 37,500 0 0 0 0
Annual Cost Burden (Dollars) 621,450 621,450 0 0 0 0
No
No

$232,690
No
    Yes
    Yes
No
No
No
Uncollected
Kira Starks 571 372-4529 danikquia.k.starks.ctr@mail.mil

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/20/2019


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