You need DD Form 3030, and this page gives you the blank plus the steps for handling it. Start with what the form does: Corporate Services Provider Application for TRICARE Provider Status. Its official title is DD 3030, Corporate Services Provider Application for TRICARE Provider Status, Aug 2017.
Next, check the edition. You want not stated, currently carried as not stated by the publisher. Then confirm the form applies to you — this is a Department of Defense form, so you use it whether you serve in the Army, Navy, Air Force, Marine Corps, Space Force or Coast Guard under Defense jurisdiction.
Once you know the form fits, find out when you file it. not stated sets the requirement, and not stated maintains the form itself. Your own command or agency adds local timing on top of that, so ask your administrative office if the deadline matters to you.
Before you download, pick your approach — editable file or printed page. What follows covers the formats first, then the entries, then what you do afterward.
Begin at the top and move down. Enter your identifying data first, then the body of the form, then the signature block. The sequence is printed in that order because entries below frequently follow from entries above.
Your first action is verification. Find the edition date on the form and match it against not stated. A mismatch means you are working from a superseded printing, and because DD forms change Department-wide rather than service by service, the office receiving it will notice.
If a particular field puzzles you, read the instructions printed on the form first, then go to not stated. When the two disagree, follow the directive.
Download the form
Begin by choosing a file. Available here: PDF. Plan for 1 pages and about 27 entries.
Download the pdf first. After it opens, test a field with your cursor. Fillable means you type, tab to the next box, and save your work inside the file. Printable means the page is a flat blank, so print it and write your answers in ink.
Prefer typing over writing. Your form will likely be scanned and emailed onward, and typed text reproduces at every stage while pen strokes fade or blur. When you do write, print in capitals so the receiving clerk can read it.
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.
Now that it is complete, send it where not stated or your local procedure says it goes. Before you do, make yourself a copy — scan it or save the file elsewhere. It costs you nothing and saves you the whole exercise if the original goes missing.
When DD Form 3030 references another form, search on the series and number. Because DD numbers are common to every military department, the number by itself identifies exactly one document.
Be careful when a procedure pairs this form with a service form. Read the prefix, not just the digits. Service forms answer to a service proponent, while DD forms answer to not stated or an equivalent Department office, and the two sequences were never aligned. Grabbing the wrong prefix gets you a form that has nothing to do with your task.
Do not archive this file and reuse it in a year. Forms are reissued as directives are revised, as data requirements shift, and as statutory notice text is amended. Your protection is simple: download fresh each time and confirm the edition date.
Finally, understand the limits of what you have read. This page distributes a published Department of Defense form and describes how to fill it out. It does not give legal or procedural advice, and it cannot promise any outcome for your particular case. For that, contact not stated, your 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?