Information Collection

TRICARE Dental Program (TDP) Claim Form

IC 5615 under ICR 200509-0720-001 · OMB 0720-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0035 can be found here:

Documents and Forms

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Information Collection (IC) Details

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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

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 Agency Discretion
Annual Number of Responses for this IC	3,503,744	3,503,744
Annual IC Time Burden (Hours)	875,936	875,936
Annual IC Cost Burden (Dollars)	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.