Information Collection

TRICARE Young Adult Application

IC 197033 under ICR 202110-0720-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,709	2,709
Annual IC Time Burden (Hours)	677	677
Annual IC Cost Burden (Dollars)	4,903	4,903

Documents for IC

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.