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Defense Department form, series DD, number 3043-2. Full title: DD3043, "Tricare Select Enrollment, Disenrollment, and Change Form". Function: TRICARE Select Enrollment, Disenrollment, and Change Form (WEST). Edition in force: not stated. Publisher 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.
Common users: service members regardless of branch, Defense civilian staff, and the offices that file, verify or retain the finished document.
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.
Available formats: PDF. The form runs 1 pages and contains approximately 183 fillable fields.
Free download applies to every format listed. Any current pdf reader opens the pdf files, though field behaviour is most reliable in a full desktop reader rather than a browser preview.
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
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.
Edition in use: not stated. Because DD forms are revised at Department level and distributed to all services at once, an obsolete printing may not match the fields an office expects. The date is printed on the form face.
Field-level instructions appear on the form itself and in not stated. The directive is the controlling text.
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.
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.
Where a DA form is cited alongside a DD form, the two belong to different systems: DA numbering is Army-specific and administered by an Army proponent, while DD numbering is Defense-wide under not stated or an equivalent Department office. Numbers do not translate between the systems.
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.
Scope of this page: distribution of a published form and description of its contents. It offers no legal guidance and no assurance regarding any particular submission. Direct procedural questions to not stated, to the servicing personnel office, or to the office designated in not stated.
Questions and answers
- What is DD Form 3043-2?
- 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?