DoD Active Duty/Reserve Forces Dental Examination

Forms and Documents

Document Name	Status
Form DD Form 2813 DoD Active Duty/Reserve Forces Dental Examination Form	Modified
Attachment_3_PIA ARMY DMSS.pdf Supplementary Document	2013-05-09
Attachment_2_ SORN A0040_5a DASG DOD.pdf Supplementary Document	2013-05-09
DD Form 2813 PAS (Electronic)_TMAPCLO Final_4-13-12.doc Supplementary Document	2013-05-03
DD Form 2813 PAS (Paper)_TMAPCLO Final_ 4-13-12.doc Supplementary Document	2013-05-03
SIGNED SSN memo.pdf Supplementary Document	2013-05-03
Supplemental_Statement 2013.docx Supporting Statement A	2013-05-10

IC Document Collections

IC ID	Document Title	Status
43598	DoD Active Duty/Reserve Forces Dental Examination Form	Modified

ICR Details

OMB Control No: 0720-0022	ICR Reference No: 201305-0720-001
Status: Historical Active	Previous ICR Reference No: 200911-0720-002
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: DoD Active Duty/Reserve Forces Dental Examination
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/06/2013
	Date Received in OIRA: 05/15/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved
Responses	712,500	0	0
Time Burden (Hours)	35,625	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The DoD must obtain the dental health status of members of the active and reserve components for deployment readiness. This form is designed to be completed by members' civilian dentists and provided to the members military organization for tracking dental health status. This form includes uses by active component members assigned to remote locations.

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Authorizing Statute(s): US Code: 10 USC 10206 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 75621	12/21/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 25430	05/01/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
DoD Active Duty/Reserve Forces Dental Examination	DD Form 2813	DoD Active Duty/Reserve Forces Dental Examination

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ICR Summary of Burden

	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	712,500	0	0	-172,500	0	885,000
Annual Time Burden (Hours)	35,625	0	0	-8,625	0	44,250
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This is a reinstatement of a previously approved collection. Previous Burden estimates were generated based on the number of forms received overall. Upon further review, the number of Respondents was reduced to match only the Civilian Dentists participating in this process. This is an adjustment to more accurately reflect this collection.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/15/2013

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