# Submission for OMB Review; Comment Request
**AGENCY:**
Office of the Assistant Secretary of Defense for Health Affairs, DoD.
**ACTION:**
30-Day information collection notice.
**SUMMARY:**
The Department of Defense has submitted to OMB for clearance the following proposal for collection of information under the provisions of the Paperwork Reduction Act.
**DATES:**
Consideration will be given to all comments received by June 20, 2019.
**ADDRESSES:**
Comments and recommendations on the proposed information collection should be emailed to Mr. John Brammer, DoD Desk Officer, at *[email protected].* Please identify the proposed information collection by DoD Desk Officer, Docket ID number, and title of the information collection.
**FOR FURTHER INFORMATION CONTACT:**
Angela James, 571-372-7574, or *[email protected]* .
**SUPPLEMENTARY INFORMATION:**
*Title; Associated Form; and OMB Number:* TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form; DD Form 2876; OMB Control Number 0720-0008.
*Type of Request:* Extension.
*Number of Respondents:* 1,520,050.
*Responses per Respondent:* 2.
*Annual Responses:* 3,040,100.
*Average Burden per Response:* 15 minutes.
*Annual Burden Hours:* 760,025 hours.
*Needs and Uses:* The information collection requirement is necessary to obtain the TRICARE beneficiary's personal information needed to: (1) Complete his/her enrollment into TRICARE Prime health plan, (2) change the beneficiary's enrollment (new Primary Care Manager, enrolled region, add/drop a dependent, etc.), or (3) disenroll the beneficiary. All TRICARE beneficiaries have the option of enrolling, changing their enrollment or dis-enrolling using the DD Form 2876, the Beneficiary Web Enrollment (BWE) portal, or by calling their regional Managed Care Support Contractor (MCSC). Although the telephonic enrollment/change is the preferred method by the large majority of beneficiaries, many beneficiaries prefer using the form to document their enrollment date and preferences.
*Affected Public:* Individuals or households.
*Frequency:* On occasion.
*Respondent's Obligation:* Voluntary.
*OMB Desk Officer:* Mr. Josh Brammer.
You may also submit comments and recommendations, identified by Docket ID number and title, by the following method:
• *Federal eRulemaking Portal: http://www.regulations.gov.* Follow the instructions for submitting comments.
*Instructions:* All submissions received must include the agency name, Docket ID number, and title for this *Federal Register* document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing on the internet at *http://www.regulations.gov* as they are received without change, including any personal identifiers or contact information.
*DOD Clearance Officer:* Ms. Angela James.
Requests for copies of the information collection proposal should be sent to Ms. James at *[email protected].*
Dated: May 15, 2019.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.