Information Collection

Reserve Component Health Coverage Request

IC 267518 under ICR 202405-0720-003 · OMB 0720-0081.

Documents and Forms

Document Name Document Type
Form DD Form 2896-1 Reserve Component Health Coverage Request Form
TRSTRR BWE Screenshots.pdf Other-Beneficiary Web Enrollment
TRSTRR BWE Screenshots.pdf Other-Beneficiary Web Enrollment
DD Form 2896-1 RESERVE COMPONENT HEALTH COVERAGE REQUEST 0720-RCHC_dd2896-1.pdf www.tricare.mil/bwe Form
DD Form 2896-1 RESERVE COMPONENT HEALTH COVERAGE REQUEST 0720-RCHC_dd2896-1.pdf www.tricare.mil/bwe Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reserve Component Health Coverage Request	Agency IC Tracking Number:	0720-RCHC

Is this a Common Form? No		IC Status: New

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
Form	DD Form 2896-1	RESERVE COMPONENT HEALTH COVERAGE REQUEST	0720-RCHC_dd2896-1.pdf	https://www.tricare.mil/bwe	Yes	Yes	Fillable Fileable
Other-Beneficiary Web Enrollment			TRSTRR BWE Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Defense Manpower Data Center (DMDC) 02 DoD, Defense Enrollment Eligibility Reporting Systems (DEERS)	FR Citation: 87 FR 32384

Number of Respondents: 98,887	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	197,774	197,774
Annual IC Time Burden (Hours)	49,444	49,444
Annual IC Cost Burden (Dollars)	358,465	358,465

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.