Professional Qualifications, Medical and Peer Reviewers

OMB 0720-0005

The information collection requirement is necessary to obtain and record the profesional 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 2021-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DHA 780 Professional Qualifications Medical/Peer Reviewers Form
Letter to OIRA Form 780.pdf Supplementary Document
0720-0005_SSA_4.29.22.docx Supporting Statement A
Professional Qualifications Medical/Peer Reviewers Form

All Historical Document Collections

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