TRICARE Dental Program (TDP) Claim Form

ICR 200509-0720-001

OMB: 0720-0035

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
5615
Migrated
ICR Details
0720-0035 200509-0720-001
Historical Active
DOD/DODOASHA
TRICARE Dental Program (TDP) Claim Form
New collection (Request for a new OMB Control Number)   No
Emergency 09/16/2005
Approved without change 09/26/2005
Retrieve Notice of Action (NOA) 09/16/2005
Approved for 6 months. DoD is reminded to publish a 60 day Federal Register Notice for public comment prior to resubmitting this collection of information to OMB for review.
  Inventory as of this Action Requested Previously Approved
03/31/2006 03/31/2006
3,503,744 0 0
875,936 0 0
0 0 0

The TRICARE Management Activity (TMA) under the authority of the Office of the Assistant Secretary of Defense (Health Affairs)/TMA Office of the Deputy Assistant Secretary of Defense manages the TRICARE dental program as established in Title X United States Code, section 1076a. The TDP claim form is required to gather information to make payment for legitimate dentail claims and to assist in contractor surveillance and program integrity investigations and to audit financial transactions where the Department of Defense has a financial stake. The information from the claim form...

None
None


No

1
IC Title Form No. Form Name
TRICARE Dental Program (TDP) Claim Form

  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 3,503,744 0 0 3,503,744 0 0
Annual Time Burden (Hours) 875,936 0 0 875,936 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
09/16/2005


© 2024 OMB.report | Privacy Policy