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DD Form 2876 — a Department of Defense document. Title of record: DD Form 2876, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form, 20160226 draft. Stated purpose: TRICARE Prime Enrollment, Disenrollment And Primary Care Manager (PCM) Change Form. Edition date not stated; status not stated.
Issued under not stated, with not stated as proponent. A DD number marks a Department-wide instrument: the same blank form serves every military department and the defense agencies, rather than one service alone.
Users include uniformed members of any branch, DoD civilian employees, contractor personnel where authorized, and the administrative staff who process the completed record.
When the form is filed is a matter of not stated and local instruction. The description here covers the document itself and how to obtain a copy.
Formats offered: PDF. Length: 5 pages. Fillable field count: roughly 152.
The pdf is the primary distribution format. A fillable pdf accepts typed entries in defined field boxes and stores them in the file; a printable pdf is a flat image of the blank, meant for pen entry after printing. The distinction matters for legibility and for records that pass between offices.
The xfdl release corresponds to IBM Lotus Forms. This format carried Department-wide form distribution for years and opens only in IBM Lotus Forms Viewer or a compatible client, not in a pdf reader.
All formats download free of charge. Pdf files open in any modern reader; interactive fields behave most predictably in a desktop application, less so in browser viewers.
What the form asks for
- Contractor's website.
- TRICARE Prime option desired. Press space bar to mark X in first box if TRICARE Prime, second box if TRICARE Prime Remote, third box if TRICARE Overseas Program Prime, or fourth box if Uniformed Services Family Health Plan.
- Section I - Sponsor information. 1. Sponsor name (last, first, middle initial) (must match DEERS).
- Sponsor's social security number or DoD Benefits Number (DBN).
- 3. Sponsor is: X first box if active duty, second box if retired, third box if deceased, or fourth box if unremarried former spouse.
- 4. Sponsor's work telephone number (include area code/extensions).
- 5. Sponsor's email address.
- 7. Sponsor's residence address (street, apartment number, city, state, zip code, country).
- X if new address.
- 8. Sponsor's mailing address (provide APO or FPO if stationed overseas).
- X if same as residence address.
- X if new address.
- 9. Sponsor's military assignment. a. Unit.
- b. Unit identification code (if known).
- c. State, zip code and country of work address.
- 10. Requested action. X first box if none for sponsor (go to section II - family), second if enroll, third if transfer enrollment, fourth if PCM change, or fifth if disenroll.
- 11. Sponsor primary care preference. a. PCM, first choice. X first box if military treatment facility, second box if PRP (active duty only), third box if civilian.
- Primary care manager full name or MTF/clinic.
- b. Second choice. X first box if military treatment facility, second box if civilian.
- Primary care manager full name or MTF/clinic.
- c. PCM specialty. X first box if no preference, second box if family/general practice, third if internal medicine, or fourth if flight medicine.
- d. Preferred PCM gender. X first box if no preference, second box if male, third box if female.
- Section II - Enrolling family members. 12.a. First family member name (last, first, middle initial) (must match DEERS).
- b. Date of birth (4 digit year, 2 digit month, 2 digit day).
Completion runs in the order printed on the page: identifying data at the head, the body of the entry next, certification at the foot. Header data frequently governs what belongs in the fields below it.
Verify the edition date against not stated before entry. Department-level revisions replace the blank across every service simultaneously, so an old copy in a desk drawer may no longer correspond to current field numbering.
Certification requires a signature in the designated block — ink on paper, or a digital signature where the receiving office supports one. Typing a name into the field does not constitute execution. CAC-based signing is the usual digital method for Defense forms.
Where personal information is collected, a Privacy Act Statement appears on or with the form. It names the collection authority, the purpose, the routine uses of the data and the consequence of withholding it. Reading it precedes filling the form.
Frequent defects: obsolete edition, unfilled required boxes, handwriting that fails on reproduction, non-conforming date format, and certification without a corresponding date.
Instructions printed on the form or in not stated govern individual field entries. Where the two differ, the governing publication controls.
Once executed, routing follows not stated and the submitting organization's own instruction. Keeping a copy is standard.
Associated forms are traced by number within the series. Because the DD sequence is common to all military departments, no service qualifier is needed to identify a referenced form.
A DD number and a DA number may appear in the same instruction without being related. DA forms belong to the Army alone; DD forms belong to the Department and are administered at Department level. The sequences are independent.
Forms are reissued for several reasons: directive revision, changed data requirements, updated notice language. Confirming not stated at the moment of download covers the risk.
The material here is descriptive. Nothing on the page constitutes legal or procedural advice, and no statement here determines whether a submitted form will be accepted. Such questions go to not stated, a servicing administrative office, or the authority identified in not stated.
Questions and answers
- What is DD Form 2876?
- DD Form 2876, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form, 20160226 draft
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?