OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Active Duty Dental Program Claim Form

OMB 0720-0053 ยท DOD/DODOASHA.

OMB 0720-0053

The information collection is necessary to obtain and record the dental readiness of Service Members using the Active Duty Dental Program (ADDP) and at the same time submit the claim form for the dental procedures provided. Many of these Service Members are not located near a military dental clinic and receive their dental care in the private sector under ADDP. The form is needed to update the dental readiness of all Service Members so that they can maintain worldwide deployment status and reduces paperwork by combining the dental claim and dental readiness into one form.

The latest form for Active Duty Dental Program Claim Form expires 2029-05-31 and is listed under ICR 202603-0720-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Active Duty Dental Program Claim FormForm
Active Duty Dental Program Claim FormForm
150917_SSN Justification 0720-0053.pdfSupplementary Document
150917_SSN Justification 0720-0053.pdfSupplementary Document
0720-0053_SSA_3.31.2026 (1).docxSupporting Statement A
0720-0053_SSA_3.31.2026 (1).docxSupporting Statement A
Active Duty Dental Program Claim Form Form
Active Duty Dental Program Claim Form Form
Active Duty Dental Program Claim Form Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202603-0720-003 Extension without change of a currently approved collection 2026-03-31
202301-0720-002 Extension without change of a currently approved collection 2023-01-31 Approved without change
201912-0720-003 Revision of a currently approved collection 2019-12-20 Approved without change
201604-0720-003 Reinstatement without change of a previously approved collection 2016-04-21 Approved with change
201207-0720-006 New collection (Request for a new OMB Control Number) 2012-07-05 Approved without change