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TRICARE Young Adult Application
TRICARE Young Adult Application
OMB: 0720-0049
IC ID: 197033
OMB.report
DOD/DODOASHA
OMB 0720-0049
ICR 202410-0720-001
IC 197033
( )
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
DD2947-1 TRICARE Young Adult Application
dd2947-1 Unlocked - PAS edits.pdf
Form and Instruction
DD2497-2 TRICARE Young Adult Application
dd2947-2 Unlocked - PAS edits.pdf
Form and Instruction
DD2947-3 TRICARE Young Adult Application
dd2947-3 Unlocked - PAS edits.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
TRICARE Young Adult Application
Agency IC Tracking Number:
0720-0049
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
DD2947-1
TRICARE Young Adult Application
dd2947-1 Unlocked - PAS edits.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
DD2497-2
TRICARE Young Adult Application
dd2947-2 Unlocked - PAS edits.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
DD2947-3
TRICARE Young Adult Application
dd2947-3 Unlocked - PAS edits.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Defense and National Security
Subfunction:
Operational Defense
Privacy Act System of Records
Title:
TRICARE YOUNG ADULT APPLICATION
FR Citation:
89 FR 63422
Number of Respondents:
7,164
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
82 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
7,164
0
4,455
0
0
2,709
Annual IC Time Burden (Hours)
1,791
0
1,114
0
0
677
Annual IC Cost Burden (Dollars)
12,967
0
8,064
0
0
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.