OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Professional Qualifications, Medical and Peer Reviewers

OMB 0720-0005 · DOD/DODOASHA.

OMB 0720-0005

The information collection requirement is necessary to obtain and record the professional qualifications of medical and peer reviews utilized within TRICARE. The form is included as an exhibit in an appeal or hearing case file as evidence of the reviewer's professional qualifications to review the medical documentation contained in the case file.

The latest form for Professional Qualifications, Medical and Peer Reviewers expires 2028-12-31 and is listed under ICR 202505-0720-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form DHA 780 PROFESSIONAL QUALIFICATIONS MEDICAL/PEER REVIEWERSForm and Instruction
Form DHA 780 Professional Qualifications Medical/Peer ReviewersForm and Instruction
0720-0005_SSA_9.23.2025.docxSupporting Statement A
Professional Qualifications Medical/Peer Reviewers Form and Instruction
Professional Qualifications Medical/Peer Reviewers Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202505-0720-001 Reinstatement without change of a previously approved collection 2025-09-23
202203-0720-006 Revision of a currently approved collection 2022-04-29 Approved without change
202102-0720-001 Revision of a currently approved collection 2021-02-26 Approved without change
201701-0720-001 Reinstatement with change of a previously approved collection 2017-01-27 Approved with change
200708-0720-002 Extension without change of a currently approved collection 2007-08-31 Approved without change
200403-0720-002 Reinstatement without change of a previously approved collection 2004-03-24 Approved with change
200007-0720-002 Reinstatement with change of a previously approved collection 2000-07-13 Approved without change
199609-0720-001 Reinstatement without change of a previously approved collection 1996-09-04 Approved without change
199303-0720-001 New collection (Request for a new OMB Control Number) 1993-03-12 Approved without change