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

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⚠️ Notice: This information collection may be referencing outdated material.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 - phone script.docx Instruction

Information Collection (IC) Details

IC Title:	TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change- phone	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
Instruction			0720-0008 - phone script.docx		No		Paper Only

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: 1,261,151	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	2,522,302	2,522,302
Annual IC Time Burden (Hours)	630,576	630,576
Annual IC Cost Burden (Dollars)	4,571,672	4,571,672

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.