Information Collection Request
TRICARE Plus Enrollment and Disenrollment Application Forms
ICR 202406-0720-001 · OMB 0720-0028 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form DD Form 2853 TRICARE Plus Enrollment Application TRICARE Plus Disenrollment Request |
Form | Modified | Repair queued |
 0720-0028_SSA_6.26.2024.docx |
Supporting Statement A | Uploaded 2024-06-26 | Repair queued |
 SSN Justifciation for DD Form 2853_2854 TRICARE Plus (Dis)Enrollment.pdf |
Supplementary Document | Uploaded 2018-02-01 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 5604 |  TRICARE Plus Enrollment Application TRICARE Plus Disenrollment Request |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOD/DODOASHA |
| OMB Control No | 0720-0028 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202104-0720-002 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |