Active Duty Dental Program Claim Form

Active Duty Dental Program Claim Form

OMB: 0720-0053

IC ID: 203005

Information Collection (IC) Details

View Information Collection (IC)

Active Duty Dental Program Claim Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Form 5579 Active Duty Dental Program Claim Form 0720-0053_ADDP-Claim-Form-fillable_6.27.2019.pdf https://secure.addp-ucci.com/dwaddw/adsm/article.xhtml?content=claims-adsm Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

75,000 0
   
Private Sector Businesses or other for-profits
 
   68 %

  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 300,000 0 0 0 0 300,000
Annual IC Time Burden (Hours) 75,000 0 0 0 0 75,000
Annual IC Cost Burden (Dollars) 1,434,000 0 126,000 0 0 1,308,000

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