OMB.report

Federal forms, ICRs, and supporting documents

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 can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Supplementary Document
Supplementary Document
Supporting Statement A
Supporting Statement A
All Historical Document Collections
 Extension without change of a currently approved collection 2025-09-29
Approved with change
 Revision of a currently approved collection 2022-08-22
Approved with change
 Extension without change of a currently approved collection 2019-05-23
Approved with change
 Revision of a currently approved collection 2016-02-29
Approved without change
 No material or nonsubstantive change to a currently approved collection 2013-03-28
Approved without change
 Revision of a currently approved collection 2012-12-07
Approved without change
 Extension without change of a currently approved collection 2010-03-01
Approved without change
 Extension without change of a currently approved collection 2007-01-08
Approved without change
 Reinstatement without change of a previously approved collection 2003-12-19
Approved without change
 Reinstatement with change of a previously approved collection 1999-09-24
Approved without change
 New collection (Request for a new OMB Control Number) 1995-06-30
OMB Details

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

Federal Enterprise Architecture: Defense and National Security - Operational Defense

Form DD2876-3TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORMmilconnect.dmdc.osd.milForm and instruction
Form DD276-2TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORMmilconnect.dmdc.osd.milForm and instruction
Form DD2876-1TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORMmilconnect.dmdc.osd.milForm and instruction

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