TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change- web portal

TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form

OMB: 0720-0008

IC ID: 236141

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change- web portal
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Web Portal 0720-0008 - BWE Screenshots.pdf https://www.dmdc.osd.mil/appj/bwe/indexAction.do Yes No Fillable Printable

Defense and National Security Operational Defense

DHA-07, Military Health Information System  78 FR 69076

113,125 0
   
Individuals or Households
 
   100 %

  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 226,250 0 0 226,250 0 0
Annual IC Time Burden (Hours) 56,563 0 0 56,563 0 0
Annual IC Cost Burden (Dollars) 410,078 0 0 410,078 0 0

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