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

ICR 202506-0720-005

OMB: 0720-0008

Federal Form Document

Forms and Documents
ICR Details
0720-0008 202506-0720-005
Received in OIRA 202204-0720-001
DOD/DODOASHA 0720-0008
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change
Extension without change of a currently approved collection   No
Regular 09/29/2025
  Requested Previously Approved
36 Months From Approved 09/30/2025
2,133,932 517,798
533,484 129,450
3,867,752 938,509

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.

US Code: 10 USC 1099 Name of Law: Health Care Enrollment System
  
None

Not associated with rulemaking

  90 FR 34249 07/21/2025
90 FR 45752 09/23/2025
No

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,133,932 517,798 0 1,616,134 0 0
Annual Time Burden (Hours) 533,484 129,450 0 404,034 0 0
Annual Cost Burden (Dollars) 3,867,752 938,509 0 2,929,243 0 0
Yes
Miscellaneous Actions
No
The total respondent labor cost has increased because of a general increase in enrollment action requests to include the T5 contract transition where beneficiaries were required to provide updated monthly payment set up information to ensure enrollment fees could continue to be collected which may be one contributing faction. Additionally, beneficiaries often request consecutive changes over time (Ex: address/PCM/monthly payment set up changes (expired credit card/debit card) which could contribute to increased collections. Additionally, the cost of first class postage has increased.

$8,177,676
No
    Yes
    Yes
No
No
No
No
Amanda Grifka 555 555-5555 amanda.b.grifka.civ@health.mil

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/29/2025


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