Active Duty Dental Program Claim Form

ICR 202301-0720-002

OMB: 0720-0053

Federal Form Document

Forms and Documents

Document Name	Status
Form Form 5579 Active Duty Dental Program Claim Form Form	Modified
0720-0053 Supporting Statement Part A.docx Supporting Statement A	2023-01-31

IC Document Collections

IC ID	Document Title	Status
203005	Active Duty Dental Program Claim Form Form	Modified