OMB control number

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

OMB 0720-0008 · DOD/DODOASHA.

OMB 0720-0008

These collection instruments serve as application for enrollment, disenrollment, and Primary Care Manager (PCM) Change for the Department of Defense's TRICARE Prime program. The information collected provides the necessary data to determine beneficiary eligibility, complete enrollment, change beneficiary's enrollment (new Primary Care Manager, enrolled region, add a dependent, etc.), or dis-enroll the beneficiary.

The latest form for TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change expires 2028-12-31 and is listed under ICR 202506-0720-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form DD2876-3 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	Form and Instruction
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	Form and Instruction
TRICARE Prime_dd876_ SSN Justification Memo_20250509.pdf	Supplementary Document
TRICARE Prime_dd876_ SSN Justification Memo_20250509.pdf	Supplementary Document
0720-0008_SSA_9.29.2025.docx	Supporting Statement A
0720-0008_SSA_9.29.2025.docx	Supporting Statement A
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Form and Instruction
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Form and Instruction
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Form and Instruction
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Form and Instruction
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change- web portal	Other-Online Submission

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202506-0720-005	Extension without change of a currently approved collection	2025-09-29
202204-0720-001	Revision of a currently approved collection	2022-08-22	Approved with change
201905-0720-001	Extension without change of a currently approved collection	2019-05-23	Approved with change
201602-0720-001	Revision of a currently approved collection	2016-02-29	Approved with change
201303-0720-001	No material or nonsubstantive change to a currently approved collection	2013-03-28	Approved without change
201212-0720-001	Revision of a currently approved collection	2012-12-07	Approved without change
201003-0720-001	Extension without change of a currently approved collection	2010-03-01	Approved without change
200612-0720-002	Extension without change of a currently approved collection	2007-01-08	Approved without change
200312-0720-001	Reinstatement without change of a previously approved collection	2003-12-19	Approved without change
199909-0720-001	Reinstatement with change of a previously approved collection	1999-09-24	Approved without change
199506-0720-001	New collection (Request for a new OMB Control Number)	1995-06-30	Approved without change

OMB Details

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

Federal Enterprise Architecture: Defense and National Security - Operational Defense

Information collection instruments
Form	Name	Electronic access	Type
Form DD2876-3	TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM	milconnect.dmdc.osd.mil	Form and instruction
Form DD276-2	TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM	milconnect.dmdc.osd.mil	Form and instruction
Form DD2876-1	TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM	milconnect.dmdc.osd.mil	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.