Download the form
DD Form 3030 — a Department of Defense document. Title of record: DD 3030, Corporate Services Provider Application for TRICARE Provider Status, Aug 2017. Stated purpose: Corporate Services Provider Application for TRICARE Provider Status. Edition date not stated; status not stated.
Governing directive: not stated. Responsible office: not stated. The DD designation signals joint scope — all military departments, combatant commands and defense agencies draw on a single edition of the document.
Users include uniformed members of any branch, DoD civilian employees, contractor personnel where authorized, and the administrative staff who process the completed record.
Timing of submission is fixed by not stated and by the implementing guidance of the submitting organization. What follows describes the blank document, not agency procedure.
Formats offered: PDF. Length: 1 pages. Fillable field count: roughly 27.
Distribution centres on pdf. Two states exist: fillable, where field boxes accept keyboard input and retain it, and printable, a static blank produced for manual completion. Typed data reproduces cleanly across copies; handwritten data depends on the writer.
What the form asks for
- Return completed form with all attachments to the following address:
- For inquiries, please call:
- 1. Provider name.
- 3.a. Institution/corporate services provider name.
- b. Corporate/foundation name (if different).
- c. Address (physical location) (street, city, state, zip code).
- d. Mailing address (if different).
- f. Facsimile number (include area code).
- g. Tax identification number.
- h. Are you a Medicare provider? X first box if yes, second if no.
- e. Telephone number (include area code).
- (2) Medicare category.
- b. Date (4 digit year, 2 digit month, 2 digit day).
- i. Are you a JCAHO accredited? X first box if yes, second if no.
- If yes: (1) Medicare certification number.
- (2) Original JCAHO classification date (4 digit year, 2 digit month, 2 digit day).
- If yes: (1) JCAHO classification.
- j. State license classification.
- (3) Current JCAHO classification dates (4 digit year, 2 digit month, 2 digit day). From:
- To:
- k. Dates of state licensure (4 digit year, 2 digit month, 2 digit day). From:
- To:
- l. Are you certified by a national board? X first box if yes, second if no.
- If yes: (1) Name of board.
Order of completion: identification block first, substantive entries second, certification and signature last. The blank is laid out in that sequence and the sequence is not arbitrary — later entries often depend on data established in the header.
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.
The signature block takes an actual signature. On paper this means ink; electronically it means a credentialed digital signature, commonly CAC-based. Typed text in a signature field satisfies neither.
Privacy Act notice: DD forms that collect personal data carry a Privacy Act Statement stating the authority for collection, the principal purpose, routine uses and whether disclosure is voluntary or mandatory. The statement is part of the form and should be read before entry, not after.
Frequent defects: obsolete edition, unfilled required boxes, handwriting that fails on reproduction, non-conforming date format, and certification without a corresponding date.
Guidance for specific entries sits on the form face and in not stated; the directive is authoritative where the two do not agree.
After completion, the copy goes to the office designated by not stated or by local procedure. Retention of a personal copy is ordinary practice and costs nothing.
Cross-referenced forms are found through the numbering system. The DD sequence is Department-level and unified, which means a number cited on the page identifies one document across the whole Department.
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.
Editions change because the underlying directive changes, because collection requirements are revised, or because Privacy Act language is updated. Checking the edition date at the point of download is the practical response.
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 3030?
- DD 3030, Corporate Services Provider Application for TRICARE Provider Status, Aug 2017
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?