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

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

Documents and Forms

Document Name Document Type
Form DD2876-1 TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form Form and Instruction
DD2876-1 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-1 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil Form and Instruction
DD2876-1 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-1 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil Form and Instruction
DD276-2 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-2 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil Form and Instruction
DD276-2 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-2 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil Form and Instruction
DD2876-3 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-3 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil Form and Instruction
DD2876-3 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CAR DD2876-3 Unlocked - admin edits don't publish yet 20250610.PDF milconnect.dmdc.osd.mil Form and Instruction

Information Collection (IC) Details

IC Title:	TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 199.17

Information Collection Instruments:

Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD2876-1	https://milconnect.dmdc.osd.mil	Yes	Yes	Fillable Fileable
Form and Instruction	DD276-2	https://milconnect.dmdc.osd.mil	Yes	Yes	Fillable Fileable
Form and Instruction	DD2876-3	https://milconnect.dmdc.osd.mil	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: DMDC 02 DoD, Defense Enrollment Eligibility Reporting System (“DEERS”)	FR Citation: 78 FR 69076

Number of Respondents: 953,841	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 26 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,907,682	1,616,134	291,548
Annual IC Time Burden (Hours)	476,921	404,034	72,887
Annual IC Cost Burden (Dollars)	3,457,674	2,929,243	528,431

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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