DoD Active Duty/Reserve Forces Dental Examination

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD3128 DEPARTMENT OF DEFENSE ACTIVE DUTY/RESERVE/GUARD/CIVILIAN FORCES DENTAL EXAMINATION	Form and Instruction	Modified	Available
0720-0022_SS-A_3.26.2026.docx	Supporting Statement A	Uploaded 2026-03-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43598	DoD Active Duty/Reserve Forces Dental Examination	Form and Instruction	Modified	DEPARTMENT OF DEFENSE ACTIVE DUTY/RESERVE/GUARD/CIVILIAN FORCES DENTAL EXAMINATION
43598	DoD Active Duty/Reserve Forces Dental Examination	Form and Instruction	Modified

ICR Details

OMB Control No: 0720-0022	ICR Reference No: 202603-0720-001
Status: Received in OIRA	Previous ICR Reference No: 202301-0720-001
Agency/Subagency: DOD/DODOASHA	Agency Tracking No: 0720-0022
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	Date Submitted to OIRA: 03/31/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2026
Responses	750,000	750,000
Time Burden (Hours)	37,500	37,500
Cost Burden (Dollars)	3,742,500	622,500

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Abstract: The DD Form 2813, “Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination” is used by members of the Active and Reserve Components of the Armed Forces and certain DoD civilians to enable civilian dentists to document and report their dental health status. It is difficult for Reserve Component members to receive their routine dental care from Active Duty dentists, but they are required to document the fact that they have undergone an annual dental examination. Therefore, this form is used as a method for civilian dentists to confirm that an exam was completed and convey the dental health status of members of the Reserve Components and Active Duty Service Members in remote locations.

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Authorizing Statute(s): US Code: 10 USC 10206 Name of Law: Armed Forces Members: Physical Examinations
   US Code: 10 USC 1074f Name of Law: Medical tracking system for members deployed overseas
  

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:
	91 FR 2924	01/23/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 14686	03/26/2026
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	DD3128	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 Request	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)	3,742,500	622,500	0	3,120,000	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: $315,000

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: 03/31/2026

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