Information Collection

TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form

IC 5574 under ICR 202506-0720-005 · OMB 0720-0008.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD2876-1 TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Form and Instruction
Form DD2876-1 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Form and Instruction
Form DD276-2 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Form and Instruction
Form DD2876-3 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Form and Instruction
DD2876-1 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-1 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil	Form and Instruction
DD2876-1 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-1 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil	Form and Instruction
DD276-2 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-2 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil	Form and Instruction
DD276-2 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-2 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil	Form and Instruction
DD2876-3 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-3 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil	Form and Instruction
DD2876-3 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-3 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 199.17

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD2876-1	https://milconnect.dmdc.osd.mil	Yes	Yes	Fillable Fileable
Form and Instruction	DD276-2	https://milconnect.dmdc.osd.mil	Yes	Yes	Fillable Fileable
Form and Instruction	DD2876-3	https://milconnect.dmdc.osd.mil	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: DMDC 02 DoD, Defense Enrollment Eligibility Reporting System (âDEERSâ)

FR Citation: 78 FR 69076

Number of Respondents: 953,841

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 26 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,907,682	1,616,134	291,548
Annual IC Time Burden (Hours)	476,921	404,034	72,887
Annual IC Cost Burden (Dollars)	3,457,674	2,929,243	528,431

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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