OMB.report

Federal forms, ICRs, and supporting documents

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
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form
 
No Modified
 
Required to Obtain or Retain Benefits
 
32 CFR 199.17

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DD2876-1 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM DD2876-1 Unlocked - admin edits don't publish yet 20250610.PDF https://milconnect.dmdc.osd.mil Yes Yes Fillable Fileable
Form and Instruction DD276-2 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM DD2876-2 Unlocked - admin edits don't publish yet 20250610.PDF https://milconnect.dmdc.osd.mil Yes Yes Fillable Fileable
Form and Instruction DD2876-3 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM DD2876-3 Unlocked - admin edits don't publish yet 20250610.PDF https://milconnect.dmdc.osd.mil Yes Yes Fillable Fileable

Defense and National Security Operational Defense

DMDC 02 DoD, Defense Enrollment Eligibility Reporting System (“DEERS”)   78 FR 69076

953,841 0
   
Individuals or Households
 
   26 %

  Approved 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 1,907,682 0 1,616,134 0 0 291,548
Annual IC Time Burden (Hours) 476,921 0 404,034 0 0 72,887
Annual IC Cost Burden (Dollars) 3,457,674 0 2,929,243 0 0 528,431

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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].