Information Collection Request
Active Duty Dental Program Claim Form
ICR 202301-0720-002 · OMB 0720-0053 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0720-0053 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form Form 5579 Active Duty Dental Program Claim Form |
Form | Modified | Repair queued |
 0720-0053 Supporting Statement Part A.docx |
Supporting Statement A | Uploaded 2023-01-31 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 203005 |  Active Duty Dental Program Claim Form |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOD/DODOASHA |
| OMB Control No | 0720-0053 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 201912-0720-003 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |