Information Collection

DoD Active Duty/Reserve Forces Dental Examination

IC 43598 under ICR 202603-0720-001 · OMB 0720-0022.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD3128 DEPARTMENT OF DEFENSE ACTIVE DUTY/RESERVE/GUARD/CIVILIAN FORCES DENTAL EXAMINATION DoD Active Duty/Reserve Forces Dental Examination	Form and Instruction
DD3128 DEPARTMENT OF DEFENSE ACTIVE DUTY/RESERVE/GUARD/CIVILIAN dd2813.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0720-0022

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD3128				Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	750,000	0	750,000
Annual IC Time Burden (Hours)	37,500	0	37,500
Annual IC Cost Burden (Dollars)	3,742,500	3,120,000	622,500

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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