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 can be found here.
Latest Forms, Documents, and Supporting Material
Document Name |
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Form and Instruction |
Form and Instruction |
Supporting Statement A |
Form DHA 780 PROFESSIONAL QUALIFICATIONS MEDICAL/PEER REVIEWERS
0720-0005_SSA_9.23.2025.docx
Professional Qualifications Medical/Peer Reviewers All Historical Document Collections
| Reinstatement without change of a previously approved collection | 2025-09-23 | ||
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Approved without change |
Revision of a currently approved collection | 2022-04-29 | |
|
Approved without change |
Revision of a currently approved collection | 2021-02-26 | |
|
Approved with change |
Reinstatement with change of a previously approved collection | 2017-01-27 | |
|
Approved without change |
Extension without change of a currently approved collection | 2007-08-31 | |
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Approved with change |
Reinstatement without change of a previously approved collection | 2004-03-24 | |
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Approved without change |
Reinstatement with change of a previously approved collection | 2000-07-13 | |
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Approved without change |
Reinstatement without change of a previously approved collection | 1996-09-04 | |
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Approved without change |
New collection (Request for a new OMB Control Number) | 1993-03-12 |