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DD Form 3043-1 — a Department of Defense document. Title of record: DD3043, "Tricare Select Enrollment, Disenrollment, and Change Form". Stated purpose: TRICARE Select Enrollment, Disenrollment, and Change Form (EAST). Edition date not stated; status not stated.
Prescribing authority: not stated. Proponent: not stated. Unlike service-specific publications, DD forms carry Department-level authority and apply across the Army, Navy, Air Force, Marine Corps, Space Force and Coast Guard when operating under Defense jurisdiction.
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.
Available formats: PDF. The form runs 1 pages and contains approximately 183 fillable fields.
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.
Every listed format is free to download. Modern pdf software handles the pdf files, with the caveat that browser-embedded viewers sometimes ignore field properties that a desktop reader honours.
What the form asks for
- AcctNum
- ActDuty
- Address
- Annual
- AppOption
- ApplicationOptTxt
- ApplicationOptions
- BankInfo
- CCNote
- CCNum
- CDC
- CDCAnnual
- CDCQuarter
- CVC
- CardholderName
- CarrierName
- Cell
- ChangeEnroll
- Checking
- ChoseCDC
- ChoseEFT
- ChoseMonthly
- ChoseOthr
- City
The document is filled from the top down. Identification precedes substance, substance precedes certification. Fields lower on the page are commonly keyed to entries made above them.
The current edition is not stated. Superseded editions of DD forms are frequently rejected at the receiving office, since Department-wide forms change centrally and older layouts lose their field correspondence. Edition date appears in the lower corner of the printed blank.
Field-level instructions appear on the form itself and in not stated. The directive is the controlling text.
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.
Some procedures pair a DD form with a service form. The two numbering systems are separate — service forms answer to a service proponent, DD forms to not stated or another Department office — and a matching number in each system means nothing.
Revision occurs when the prescribing directive is reissued, when the data collected changes, or when statutory notice language is amended. Verification of the edition date at download addresses all three.
This page distributes a published Department of Defense document and describes it. It is not a source of legal advice and makes no representation about acceptance of any completed form. Questions of applicability, eligibility or procedure belong to not stated, the servicing personnel office, or the office named in not stated.
Questions and answers
- What is DD Form 3043-1?
- DD3043, "Tricare Select Enrollment, Disenrollment, and Change Form"
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?