DoD Active Duty/Reserve Forces Dental Examination

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 2813 Department of Defense Active Duty / Reserve / Guard / Civilian Forces Dental Examination	Form	Modified	Available
Form DD Form 2813 DoD Active Duty/Reserve Forces Dental Examination	Form	Unchanged	Repair queued
0720-0022_SS-A_1.27.2023.docx	Supporting Statement A	Uploaded 2023-01-31	Repair queued
SIGNED SSN memo.pdf	Supplementary Document	Uploaded 2019-12-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43598	DoD Active Duty/Reserve Forces Dental Examination	Form	Modified	Department of Defense Active Duty / Reserve / Guard / Civilian Forces Dental Examination
43598	DoD Active Duty/Reserve Forces Dental Examination	Form	Unchanged

ICR Details

OMB Control No: 0720-0022	ICR Reference No: 202301-0720-001
Status: Historical Active	Previous ICR Reference No: 201912-0720-002
Agency/Subagency: DOW/DODOASHA	Agency Tracking No:
Title: DoD Active Duty/Reserve Forces Dental Examination
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/13/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/31/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved	03/31/2023
Responses	750,000	0	750,000
Time Burden (Hours)	37,500	0	37,500
Cost Burden (Dollars)	622,500	0	621,450

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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: Armed Forces Members: Physical Examinations
  

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:
	87 FR 72971	11/28/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 5866	01/30/2023
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
DoD Active Duty/Reserve Forces Dental Examination	DD Form 2813	Department of Defense Active Duty / Reserve / Guard / Civilian Forces Dental Examination

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ICR Summary of Burden

table that charts list 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	750,000	750,000	0	0	0	0
Annual Time Burden (Hours)	37,500	37,500	0	0	0	0
Annual Cost Burden (Dollars)	622,500	621,450	0	1,050	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $232,690

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 01/31/2023

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