View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0720-0049	ICR Reference No: 202410-0720-001
Status: Active	Previous ICR Reference No: 202110-0720-002
Agency/Subagency: DOD/DODOASHA	Agency Tracking No: 0720-0049
Title: TRICARE Young Adult Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/18/2025
	Date Received in OIRA: 12/10/2024
Terms of Clearance: Approved contingent on DOD updating the online system to be compliant with EO 14168 at the next scheduled update on 6/19/2025.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2028	36 Months From Approved	04/30/2025
Responses	7,164	0	2,709
Time Burden (Hours)	1,791	0	677
Cost Burden (Dollars)	12,967	0	4,903

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
TRICARE Young Adult Application	DD2947-1, DD2947-3, DD2497-2	, ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	7,164	2,709	4,455
Annual Time Burden (Hours)	1,791	677	1,114
Annual Cost Burden (Dollars)	12,967	4,903	8,064

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Increased burden due to updated estimates of number of beneficiaries who are using the form.

Annual Cost to Federal Government: $41,300

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Amanda Grifka 555 555-5555 amanda.b.grifka.civ@health.mil

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.