Information Collection

TRICARE Young Adult Application

IC 197033 under ICR 201809-0720-001 · OMB 0720-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0049 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Beneficiary Web Enrollment Welcome Screen.pdf www.dmdc.osd.mil/appj/bwe/indexAction.do;jsessionid=Qx3x63ey1jUwW94oZ3ZekwRumxOExFu5eGtCsnspVb0ETeO2dq4b!-138697852	Instruction
DD-2947-1 TRICARE Young Adult Application dd2947-1 draft 20180927 locked.pdf	Form and Instruction
DD-2947-2 TRICARE Young Adult Application dd2947-2 draft 20180927 locked.pdf	Form and Instruction
DD-2947-3 TRICARE Young Adult Application dd2947-3 draft 20180927 locked.pdf	Form and Instruction

IC Title:

TRICARE Young Adult Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Beneficiary Web Enrollment Welcome Screen.pdf	https://www.dmdc.osd.mil/appj/bwe/indexAction.do;jsessionid=Qx3x63ey1jUwW94oZ3ZekwRumxOExFu5eGtCsnspVb0ETeO2dq4b!-138697852	Yes	Yes	Fillable Fileable Signable
Form and Instruction	DD-2947-1	TRICARE Young Adult Application	dd2947-1 draft 20180927 locked.pdf		Yes	Yes	Fillable Fileable Signable
Form and Instruction	DD-2947-2	TRICARE Young Adult Application	dd2947-2 draft 20180927 locked.pdf		Yes	Yes	Fillable Fileable Signable
Form and Instruction	DD-2947-3	TRICARE Young Adult Application	dd2947-3 draft 20180927 locked.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,709

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 21 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,709	-32,000	2,709	32,000
Annual IC Time Burden (Hours)	677	-8,000	677	8,000
Annual IC Cost Burden (Dollars)	4,903	0	4,903	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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