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

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0008 can be found here:

Documents and Forms

Document Name Document Type
0720-0008 - BWE Screenshots.pdf www.dmdc.osd.mil/appj/bwe/indexAction.do Other-Web Portal

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Portal			0720-0008 - BWE Screenshots.pdf	https://www.dmdc.osd.mil/appj/bwe/indexAction.do	Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: DHA-07, Military Health Information System	FR Citation: 78 FR 69076

Number of Respondents: 113,125	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	226,250	226,250
Annual IC Time Burden (Hours)	56,563	56,563
Annual IC Cost Burden (Dollars)	410,078	410,078

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.