TRICARE Retiree Dental Program Enrollment Appication

TRICARE Retiree Dental Program Enrollment Appication

OMB: 0720-0015

IC ID: 5586

Information Collection (IC) Details

View Information Collection (IC)

TRICARE Retiree Dental Program Enrollment Appication
 
No Modified
 
Required to Obtain or Retain Benefits
 
32 CFR 199.22

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Delta Dental Form TRICARE Retiree Dental Program Enrollment Application Dental Form.pdf Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

71,332 0
   
Individuals or Households
 
   25 %

  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 71,332 0 0 21,332 0 50,000
Annual IC Time Burden (Hours) 17,833 0 0 10,333 0 7,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy