The DD-2642, “TRICARE DoD/ CHAMPUS Medical Claim Patient’s Request for Medical Payment” form is used by TRICARE beneficiaries to claim reimbursement for medical expenses under the TRICARE Program (formerly the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).
The latest form for TRICARE DoD/CHAMPUS Medical Claim Patient's Request for Medical Payment expires 2021-10-31 and can be found here.
Document Name |
---|
Form and Instruction |
Supporting Statement A |
Supplementary Document |
Approved with change |
Revision of a currently approved collection | 2021-10-25 | |
Approved without change |
Extension without change of a currently approved collection | 2018-08-30 | |
Approved without change |
Reinstatement without change of a previously approved collection | 2015-02-04 | |
Approved without change |
Reinstatement without change of a previously approved collection | 2009-11-16 | |
Approved without change |
Extension without change of a currently approved collection | 2006-06-26 | |
Approved without change |
Reinstatement with change of a previously approved collection | 2003-01-30 | |
Approved without change |
Extension without change of a currently approved collection | 1999-08-04 | |
Approved without change |
Reinstatement with change of a previously approved collection | 1996-08-29 | |
Approved without change |
New collection (Request for a new OMB Control Number) | 1993-04-08 |