SUPPORTING STATEMENT – PART A
TRICARE Prime Enrollment, Disenrollment, and Change of Primary Care Manager (PCM)
0720-0008
Summary of Changes from Previously Approved Collection
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1. Need for the Information Collection
The information collection requirement is necessary to obtain non-active duty TRICARE beneficiary’s personal information needed to (1) Complete enrollment into TRICARE Prime health plan, (2) change the beneficiary's enrollment (new Primary Care Manager, enrolled region, add/drop a dependent, etc.), or (3) disenroll the beneficiary. This information is required to ensure the beneficiary’s benefits and claims are administered based on their plan of choice. Without this information each non-active duty TRICARE beneficiary is automatically defaulted into direct care only, limiting their health care options to military hospitals and clinics. These beneficiaries would have no TRICARE coverage when using the TRICARE network of providers for services not available at their local military hospital or clinic.
The authority for this collection comes from 10 U.S. Code § 1099, Health Care Enrollment System,” and 32 CFR § 199.17 “TRICARE Program.”
2. Use of the Information
Any non-active duty TRICARE beneficiary not eligible for Medicare has the option of using a physical copy of the DD Form 2876 “TRICARE Prime Enrollment, Disenrollment, and Change of Primary Care Manager” or the Beneficiary Web Enrollment (BWE) portal to enroll, disenroll or change their enrollment.
If respondents choose to use the DD Form2876 for their region, they must complete a physical copy of the form and mail the form to their appropriate regional contractor. No other form is required to enroll, disenroll or change an enrollment. Respondents can download a copy of the form with instructions from the DoD Forms website at https://www.esd.whs.mil/Directives/forms/dd2500_2999/, TRICARE.mil, their regional contractor’s website, or they may obtain a copy from their local military hospital or clinic. The mailing address and toll-free customer service number for the appropriate regional contractor are included on the all versions of DD-2876 (DD2876-1 (East)), DD2876-2 (West)) and (DD2876-3 (Overseas)).
The respondents can also use the form to enroll or change the enrollment of any non-active duty family members. With few exceptions, all respondents eligible for TRICARE must enroll in the TRICARE plan option best for themselves and any family members starting January 1, 2018: TRICARE Prime or TRICARE Select. If a beneficiary does not enroll in either plan option, they would have no TRICARE coverage when using the TRICARE network of providers for services not available at their local military hospital or clinic. The information is used only by the regional contractor to formally enroll, disenroll or change an enrollment for the beneficiary(ies) listed on the form. The contractor is responsible for completing the requested action. The form is not provided to any other party, although when the requested action is updated, it is electronically shared with other TRICARE contractors as appropriate, i.e., the pharmacy contractor, to ensure benefits and claims are correctly administered. The action is also stored in the Defense Enrollment Eligibility Reporting System (DEERS), a computerized database of military sponsors, families and others worldwide who are entitled under the law to TRICARE benefits.
Respondents may also request enrollment, disenrollment or changes via the BWE portal at https://www.tricare.mil/bwe, with links to the BWE portal available on https://www.tricare.mil and the regional contractor’s websites. The regional contractor has six days to approve and process the requested action or to request additional information. Approximately 70,000 enrollments, disenrollments or enrollment changes are initiated through BWE. Periodic articles are published reminding beneficiaries of the BWE portal at https://www.military.com/benefits/tricare/tricare-beneficiary-web-enrollment.html.
The information collected ensures a beneficiary is eligible for TRICARE and TRICARE enrollment is correctly updated to reflect their TRICARE plan of choice, address, etc. If the beneficiary does not use the form or BWE portal to enroll in a TRICARE plan option, the TRICARE beneficiary is defaulted into direct care only, limiting their health care options to only military hospitals and clinics.
3. Use of Information Technology
44% of the information is collected electronically through the BWE Portal. The other 56% is collected on paper, via the respective DD-2876. Beneficiaries are highly encouraged to use the electronic submission, the BWE Portal, however since the enrollment process for entitled healthcare is vital and not everyone will have access to a computer, electronic submission will not be mandated; representatives will continue to empathize the availability of electronic submission through the BWE Portal. Currently, there are no specified plans in place to increase the use of the information technology and electronic submissions in the future.
4. Non-duplication
The information obtained through this collection is unique and is not available for use or adaptation from another cleared source.
5. Burden on Small Businesses
This information collection does not impose a significant economic impact on a substantial number of small businesses or entities.
6. Less Frequent Collection
Collection is on an as needed basis and is driven by qualifying life events which are not based on a standardized timeline. The non-active duty TRICARE beneficiary submits the DD Form 2876 or submits their request via the BWE Portal for initially enrolling in TRICARE Prime, disenrolling, changing their enrollment (new Primary Care Manager, enrolled region, add/drop a dependent, etc.). Less frequent collection would result in a beneficiary not having healthcare coverage under a TRICARE plan.
7. Paperwork Reduction Act Guidelines
There are no special circumstances that require the collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2).
8. Consultation and Public Comments
Part A: PUBLIC NOTICE
A 60-day notice published in the Federal Register on Friday, April 29, 2022. The 60-Day FRN citation is 87 FR 25473.
No comments were received during the 60-Day Comment Period.
A 30-Day Federal Register Notice for the collection published on Monday, August 22, 2022. The 30-Day FRN citation is 87 FRN 51390.
Part B: CONSULTATION
The DD Form 2876 series is reviewed at least every three years or when policies or processes are changed that impact the Form. This first edition of the forms were created with input from the TRICARE Health Plan, Uniformed Services, TRICARE Regional Office and Regional Contractor’s enrollment subject matter experts.
9. Gifts or Payment
No gifts or payments are provided to respondents.
10. Confidentiality
A Privacy Act Statement is required for this collection and provided on the top of the form and as a disclaimer when accomplishing a request via BWE.
The applicable System of Record Notice (SORN) is DHA-07, Military Health Information System, located at: https://dpcld.defense.gov/Portals/49/Documents/Privacy/SORNs/DHA/EDHA-07.pdf
The Privacy Impact Assessment (PIA) the Defense Enrollment Eligibility Reporting System (DEERS) can be accessed using the following URL: https://dwp.dmdc.osd.mil/dwp/app/about/documents
Records Retention and Disposition Schedule:
Records will be maintained in accordance with the following approved schedule:
FILE NUMBER: 911-01
DISPOSITION: Temporary. Cut off at end of the calendar year in which received. Destroy 10 years after cutoff.
AUTHORITY: DAA-0330-2014-0014-0001
PRIVACY ACT: EDTMA 04
11. Sensitive Questions
The form requests the applicant to provide a personal identifier number, which may be either the individual’s social security number (SSN) or their DoD Benefit Number (DBN). The DBN has yet to be widely used and known by beneficiaries or the providers for healthcare transactions. Additionally, the main data source to find the DBN is the Uniformed Services identification card (ID card). Since some applicants are former dependent children who never obtained a new ID card with the DBN included or they no longer have access to their DBN when they turned in their ID card after aging out of military benefits, the SSN can still be used. Still other beneficiaries may not have requested a new ID card, so only their sponsor’s SSN is on their current card. For these reasons, DHA has justified the continued use of the SSN until such time the DBN is readily known by beneficiaries through repeated use and through means of knowing the DBN from documents other than the ID card. An SSN Justification Memo is included with this package to OMB.
12. Respondent Burden and its Labor Costs
Part A: ESTIMATION OF RESPONENT BURDEN
DD 2876
Number of Respondents: 145,774
Number of Responses Per Respondent: 2
Number of Total Annual Responses: 291,548
Response Time: 15 minutes
Respondent Burden Hours: 72,887 hours
Collection Instrument(s)
Beneficiary Web Enrollment
Number of Respondents: 113,125
Number of Responses Per Respondent: 2
Number of Total Annual Responses: 226,250
Response Time: 15 minutes
Respondent Burden Hours: 56,562.5 hours
Total Submission Burden
Total Number of Respondents: 258,899
Total Number of Annual Responses: 517,798
Total Respondent Burden Hours: 129,449.5
The estimated number of respondents and annual burden hours were taken from the enrollment reports submitted by the Regional Contractors for the current TRICARE Prime enrollees.
Part B: LABOR COST OF RESPONDENT BURDEN
Collection Instrument(s)
DD Form 2876
Number of Total Annual Responses: 291,548
Response Time: 15 minutes
Respondent Hourly Wage: $7.25
Labor Burden per Response: $1.81
Total Labor Burden: $528,430.75
Collection Instrument(s)
Beneficiary Web Enrollment
Number of Total Annual Responses: 226,250
Response Time: 15 minutes
Respondent Hourly Wage: $7.25
Labor Burden per Response: $1.81
Total Labor Burden: $410,078.13
The Respondent hourly wage was determined by using the Department of Labor Website http://www.dol.gov/dol/topic/wages/index.htm
13. Respondent Costs Other Than Burden Hour Costs
We estimate 1,520,050 respondents will annually complete the form and mail it to their Regional Contractor for processing. Based on the 2022 Postage Rate of $0.58 per first class letter, the total costs for the mailings is $881,629.
14. Cost to the Federal Government
Part A: LABOR COST TO THE FEDERAL GOVERNMENT
Collection Instrument
DD Form 2876
Number of Total Annual Responses: 291,548
Processing Time per Response: 15 minutes
Hourly Wage of Worker(s) Processing Responses: $23.06
Cost to Process Each Response: $5.77
Total Cost to Process Responses: $1,680,774.22
Collection Instrument
Beneficiary Web Enrollment (Note: information submitted through BWE portal feeds directly into DEERS with no individual processing the action request and no incurred labor cost to the federal government.)
Number of Total Annual Responses: 226,250
Processing Time per Response: N/A
Hourly Wage of Worker(s) Processing Responses: N/A
Cost to Process each Response: N/A
Total Cost to Process Responses: N/A
Hourly wage was provided by the Program Office as the average wage of contracted individuals in the processing office.
Part B: OPERATIONAL AND MAINTENANCE COSTS
Cost Categories
Equipment: $0
Printing: $0
Postage: $0
Software Purchases: $0
Licensing Costs: $0
Other: $0
Total Operational and Maintenance Cost: $0
Part C: TOTAL COST TO THE FEDERAL GOVERNMENT
Total Labor Cost to the Federal Government: $1,680,774.22
Total Operational and Maintenance Costs: $0
Total Cost to the Federal Government: $1,680,774.22
15. Reasons for Change in Burden
The burden decreased since the last approval due to the removal of the TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager Change phone calls.
The results of this information collection will not be published.
17. Non-Display of OMB Expiration Date
We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.
18. Exceptions to “Certification for Paperwork Reduction Submissions”
We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Patricia Toppings |
| File Modified | 0000-00-00 |
| File Created | 2022-08-30 |