TRICARE Plus Enrollment Application TRICARE Plus Disenrollment Request

TRICARE Plus Enrollment Application TRICARE Plus Disenrollment Request

OMB: 0720-0028

IC ID: 5604

Information Collection (IC) Details

View Information Collection (IC)

TRICARE Plus Enrollment Application TRICARE Plus Disenrollment Request
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DD From 2852 TRICARE Plus Enrollment Application dd2853.pdf Yes No Fillable Printable
Form DD Form 2854 TRICARE Plus Disenrollment Form dd2854.pdf Yes No Fillable Printable

Defense and National Security Operational Defense

 

25,065 0
   
Individuals or Households
 
   15 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 25,065 0 0 10,776 14,289 0
Annual IC Time Burden (Hours) 2,933 0 0 1,397 1,536 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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