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DD Form 3043 — 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). 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.
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.
Formats offered: PDF. Length: 1 pages. Fillable field count: roughly 182.
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
- 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 Superseded editions of DD forms are frequently rejected at the receiving office, since Department-wide forms change centrally and older layouts lose their field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.
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?
- 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?