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Department of Defense form 3043-3. Official designation: DD3043, "Tricare Select Enrollment, Disenrollment, and Change Form". Purpose: TRICARE Select Enrollment, Disenrollment, and Change Form (OVERSEAS). Current edition 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.
The download set covers PDF. Document length is 1 pages with about 183 entry fields.
Pdf serves as the base format. In the fillable variant, each box is an interactive field that holds typed text inside the document. In the flat printable variant, no fields exist — the page prints as a blank to be completed by hand. Typed entries survive transmission; handwriting does not always survive scanning.
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.
Signature is manual ink on printed copies and digital where the receiving system accepts it. A typed name in a signature field is a name, not a signature. Common Access Card credentials support digital signature in pdf where the form and the reader permit.
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.
The completed document moves to the office named in not stated or in local guidance. A retained copy is conventional practice.
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.
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.
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.
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 3043-3?
- 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?