Active Duty Dental Program Claim Form

Active Duty Dental Program Claim Form

OMB: 0720-0053

IC ID: 203005

Documents and Forms
Information Collection (IC) Details

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Active Duty Dental Program Claim Form
 
No New
 
Required to Obtain or Retain Benefits
 
32 CFR 199

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction United Concordia Claim Form Active Duty Dental Program ADDP Draft Claim Form.pdf Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

59,000 0
   
Private Sector Businesses or other for-profits
 
   60 %

  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 177,000 0 177,000 0 0 0
Annual IC Time Burden (Hours) 14,750 0 14,750 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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