DoD Active Duty/Reserve Forces Dental Examination

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0022 can be found here:

Documents and Forms

Document Name Document Type
Form DD Form 2813 DoD Active Duty/Reserve Forces Dental Examination Form
DD Form 2813 Department of Defense Active Duty / Reserve / Guard / Ci DD 2813 20160831.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DoD Active Duty/Reserve Forces Dental Examination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 2813	Department of Defense Active Duty / Reserve / Guard / Civilian Forces Dental Examination	DD 2813 20160831.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: Health Care and Medical Treatment Record System	FR Citation: 68 FR 16484

Number of Respondents: 150,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	750,000	37,500	712,500
Annual IC Time Burden (Hours)	37,500	1,875	35,625
Annual IC Cost Burden (Dollars)	621,450	621,450	0

Documents for IC

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.