Supporting Statement for OMB#0720-0022 DD Form 2813

SUPPORTING STATEMENT FOR PAPERWORK

REDUCTION ACT SUBMISSION — 0720-0022

DD Form 2813

1. Need and Use. This form is used by members of the Reserve Components of the Armed Forces to allow their civilian dentists to document and report their dental health status. It is very difficult for Reserve component members to receive their routine dental care from active duty dentists, but they are required to document the fact that they have undergone an annual dental examination. Therefore, this form is used as a method for civilian dentists to confirm that an exam was completed and convey the dental health status of members of the Reserve Components and active duty members in remote locations to the Department of Defense. Authority is found in 10 U.S.C. Section 10206.

2. Purpose and Users of the Information. The collection of this information is required to verify the health status of members of the Reserve Components and active duty members in remote locations by the Department of Defense. This is necessary to assess their readiness to deploy for military operations. Military members must maintain an acceptable level of dental health because dental emergencies in military operations place an undue strain on the health care and medical evacuation systems in the area of military operations.

3. Information Collection Techniques. When members of the Active or Reserve Components receive their annual examinations from civilian dentists, the dentists record the dental health status on this form according to dental health status definitions on the form. Members return the form to their parent military organization, and their dental health status is entered into an electronic database, which tracks the deployments readiness of the members. The DD Form 2813 is available in several electronic formats. Civilian dentists can access the form and submit it electronically to the member’s unit, although most are completing the form as part of the exam. The member can then submit the signed form electronically.

4. Duplication. Personnel dental health status is unique data that is not tracked in other data collection systems.

5. Small Businesses. This information collection does not have a significant economic impact on small businesses or entities.

6. Consequences of Not Collecting the Information. A member’s dental health status can quickly deteriorate to an unacceptable level and must be evaluated annually.

7. Special Circumstances. None. This collection of information is consistent with the guidelines in 5 CFR 1320.5(d)(2).

8. Notice and Comment. Notice has been made in the Federal Register, August 3, 2009 (74 FR 38421-38422). No comments were received.

9. Payment/Gifts. No payment or gift will be provided to the respondents. Individual dentists will decide if they require an additional fee for completing the form, or whether they will factor it into their cost of doing business.

10. Confidentiality. The form will be filed in each service member’s dental record, which contains a Privacy Act Statement.

11. Sensitive Questions. There are no questions of a sensitive nature asked on the attached forms.

12. Burden and Annualized Cost Information:

Estimated Respondents: 885,000

Response Time: 3 minutes

Response frequency: once per year

Burden hours: 44,250

The individual cost to the provider is the part of the cost of doing business.

13. Cost to Respondents. There will be no additional cost burden to respondents.

14. Cost to the Government. There will be a minimal cost to the government as the form is designed to be electronically distributed and printed by the military organizations that use the form.

15. This is a reinstatement of a previously approved collection.

16. Publication. There is no plan to publish or tabulate the information collected in an independent report. Data will be entered into an electronic database.

17. Expiration Date.

Approval not to display the expiration date is not being sought.

18. Exceptions.

No exceptions to the certification statement are requested.

B. Collections of Information Employing Statistical Methods.

This collection of information does not employ statistical methods.