Document
Submission for OMB Review; Comment Request
The DoD has submitted to the Office of Management and Budget (OMB) for clearance the following proposal for collection of information under the provisions of the Paperwork Reduc...
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB Number:
Active Duty Dental Program (ADDP) Claim Form; OMB Control Number 0720-0053.
Type of Request:
Extension.
Number of Respondents:
75,000.
Responses per Respondent:
4.
Annual Responses:
300,000.
Average Burden per Response:
15 minutes.
Annual Burden Hours:
75,000.
Needs and Uses:
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 for the dental procedures provided so that claims can be processed and reimbursement made to the provider. Many Service Members are not located near a military dental treatment facility and receive their dental care in the private sector.
Affected Public:
Business or other for-profit; individuals or households.
Frequency:
On occasion.
Respondent's Obligation:
Voluntary.
OMB Desk Officer:
Mr. Matthew Eliseo.
You may also submit comments and recommendations, identified by Docket ID number and title, by the following method:
Instructions:
All submissions received must include the agency name, Docket ID number, and title for this
Federal Register
document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing on the internet at
http://www.regulations.gov
as they are received without change, including any personal identifiers or contact information.
DoD Clearance Officer:
Ms. Angela Duncan.
Requests for copies of the information collection proposal should be sent to Ms. Duncan at
whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil.
Dated: January 25, 2023.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.