TRICARE Retiree Dental Program Enrollment Application

TRICARE Retiree Dental Program Enrollment Application

OMB: 0720-0015

IC ID: 5585

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TRICARE Retiree Dental Program Enrollment Application
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability


    

50,000 0
   
Individuals or Households
 
   15 %

  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 50,000 0 0 -236,570 0 286,570
Annual IC Time Burden (Hours) 12,500 0 0 -59,140 0 71,640
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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