TRICARE Young Adult Application

OMB 0720-0049

The Ike Skelton National Defense Authorization Act for Fiscal Year 2011 (FY11), Section 702, aligns TRICARE Program eligibility by providing a means to extend the age of eligibility of TRICARE dependents from age 21 or 23 up to age 26 to allow the purchase of extended dependent medical coverage across existing TRICARE program options (Standard, Extra, and Prime). This is consistent with the intent of the Patient Protection and Affordable Care Act, the implementing Health and Human Services regulations, and the limitations of Chapter 55 of Title 10. Information gathered through this collection will be used by the regional managed care support contractors to process the applications to start, change, or terminate TRICARE Young Adult coverage.

The latest form for TRICARE Young Adult Application expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
0720-0049_SSA 12.30.2021.docx Supporting Statement A
TYA SSN Justification Memo PCLO Signature RK.pdf Supplementary Document
TRICARE Young Adult Application Instruction

All Historical Document Collections

202110-0720-002 Approved without change	Extension without change of a currently approved collection	2021-12-30
201809-0720-001 Approved without change	Revision of a currently approved collection	2018-09-28
201504-0720-001 Approved without change	Reinstatement without change of a previously approved collection	2015-08-17
201110-0720-001 Approved without change	Revision of a currently approved collection	2011-10-31
201105-0720-001 Approved without change	Revision of a currently approved collection	2011-05-02
201103-0720-001 Preapproved	New collection (Request for a new OMB Control Number)	2011-03-22