SUPPORTING STATEMENT FOR PAPERWORK
REDUCTION ACT SUBMISSION — 0720-0022
DD Form 2813
A. JUSTIFICATION
1. Need for the Information Collection
This form is used by members of the Active and Reserve Components of the Armed Forces and certain DoD civilians to enable 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. Use of the Information
The collection of this information is required to verify the health status of members of the Reserve Components, active duty members in remote locations and DoD civilians who deploy 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. Use of Information Technology
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, the Defense Medical Surveillance System, 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.
4. Non-duplication
Personnel dental health status is unique data that is not tracked in other data collection systems.
This information collection does not have a significant economic impact on small businesses or entities.
6. Less Frequent Collection
A member’s dental health status can quickly deteriorate to an unacceptable level and must be evaluated annually. An annual dental evaluation is a readiness requirement.
7. Paperwork Reduction Act Guidelines
None. This collection of information is consistent with the guidelines in 5 CFR 1320.5(d)(2).
8. Consultation and Public Comments
Notice has been made in the Federal Register, December 21, 2012 (74 FR 38421-38422). No comments were received.
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. For active duty members who receive their care from civilian dentists through the Active Duty Dental Program, there is no fee associated with completion of this form.
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. Respondent Burden, and its Labor Costs
a. Estimation of Respondent Burden
Estimated Respondents: 150,000
Response Time: 3 minutes
Response per Respondent: 4.75
Total Annual Responses: 712,500
Burden hours: 35,625
b. Labor Cost of Respondent Burden
There are no additional costs involved in the completion of this form as it is included in the documentation of the accomplishment of a clinical dental examination.
13. Respondent Costs Other Than Burden Hour Costs
There will be no additional cost burden to respondents.
14. Cost to the Federal 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 as necessary.
15. Reasons for Change in Burden
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.
16. Publication of Results
There is no plan to publish or tabulate the information collected in an independent report. Data will be entered into an electronic database.
17. Non-Display of OMB Expiration Date
Approval not to display the expiration date is not being sought.
18. Exceptions to "Certification for Paperwork Reduction Submissions"
No exceptions to the certification statement are requested.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Patricia Toppings |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |