Continued Health Care Benefit Program (CHCBP) Application

OMB 0720-0066

The information collected on the Department of Defense (DD) Form 2837, Continued Health Care Benefit Program (CHCBP) Application, is needed to determine a former military beneficiary’s eligibility to purchase CHCBP coverage, which is optional continuation coverage after the former member or former beneficiary loses entitlement to military health benefits coverage under Title 10 United States Code (10 USC), Chapter 55. Provision of the information requested on the DD Form 2837 is required to obtain or retain benefits, or eligibility for CHCBP coverage cannot be determined and must be denied.

The latest form for Continued Health Care Benefit Program (CHCBP) Application expires 2023-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DD Form 2837 Continued Health Care Benefit Program (CHCBP) Application Form
0720-0066_SSA_08.31.2023.docx Supporting Statement A
0720-0066_SSNJ_6.15.2023.pdf Supplementary Document
Continued Health Care Benefit Program (CHCBP) Application Form

All Historical Document Collections

202305-0720-002 Approved without change	Extension without change of a currently approved collection	2023-08-31
202008-0720-001 Approved without change	Reinstatement with change of a previously approved collection	2020-08-06