TRICARE Young Adult Application

ICR 202410-0720-001

OMB: 0720-0049

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2024-10-10
Supporting Statement A
2024-12-10
IC Document Collections
IC ID
Document
Title
Status
197033 Modified
ICR Details
0720-0049 202410-0720-001
Received in OIRA 202110-0720-002
DOD/DODOASHA 0720-0049
TRICARE Young Adult Application
Revision of a currently approved collection   No
Regular 12/10/2024
  Requested Previously Approved
36 Months From Approved 01/31/2025
7,164 2,709
1,791 677
12,967 4,903

The Ike Skelton National Defense Authorization Act for Fiscal Year 2011 (FY11), Section 702, aligns TRICARE Program eligibility by providing a means to extend the age of eligibility of TRICARE dependents from age 21 or 23 up to age 26 to allow the purchase of extended dependent medical coverage across existing TRICARE program options (Standard, Extra, and Prime). This is consistent with the intent of the Patient Protection and Affordable Care Act, the implementing Health and Human Services regulations, and the limitations of Chapter 55 of Title 10. Information gathered through this collection will be used by the regional managed care support contractors to process the applications to start, change, or terminate TRICARE Young Adult coverage.

PL: Pub.L. 111 - 383 702 Name of Law: Ike Skelton National Defense Authorization Act for FY11
  
None

Not associated with rulemaking

  89 FR 63422 08/05/2024
89 FR 99234 12/10/2024
Yes

1
IC Title Form No. Form Name
TRICARE Young Adult Application DD2947-1, DD2947-3, DD2497-2 TRICARE Young Adult Application ,   TRICARE Young Adult Application ,   TRICARE Young Adult Application

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 7,164 2,709 0 4,455 0 0
Annual Time Burden (Hours) 1,791 677 0 1,114 0 0
Annual Cost Burden (Dollars) 12,967 4,903 0 8,064 0 0
Yes
Miscellaneous Actions
No
Increased burden due to updated estimates of number of beneficiaries who are using the form.

$41,300
No
    Yes
    Yes
No
No
No
No
Amanda Grifka 555 555-5555 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/10/2024


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