You have arrived looking for DD Form 3043. Before you download, confirm this is the right document: TRICARE Select Enrollment, Disenrollment, and Change Form). Full title: DD3043, "Tricare Select Enrollment, Disenrollment, and Change Form".
Your second step is the edition, not stated, listed as not stated. Your third is scope. Because the number carries a DD prefix, you use the same blank as every other military department and defense agency; no service-specific version exists for you to hunt down.
Then settle the schedule. You are working under not stated, with not stated responsible for the document, and your organization layers its own deadlines on that. Ask before you assume a date.
Last in this stage, choose your method: complete it on screen, or print the blank form and fill it out in pen. The sections below take each route step by step.
Start at the header. Complete your identification before anything else, then work through the main entries, then finish at the certification. Skipping around causes contradictions between the top of the form and the bottom.
Before your first entry, look at the corner of the page and compare the printed date with not stated. If they do not match, stop and download again. Old copies circulate in shared drives for years, and a DD form is revised centrally for every service at once, so a superseded blank may not carry the fields your reviewer expects.
For questions about a specific entry, check the form's own instructions, and if that does not settle it, open not stated. The directive controls where they differ.
Download the form
First, look at what you can download. The set covers PDF, the form runs 1 pages, and you will complete roughly 182 fields.
Handle xfdl in two steps. First confirm you have IBM Lotus Forms Viewer or a compatible reader on your machine; ordinary pdf software will report the file as broken. Once the viewer is running, download and fill the form.
Whichever you pick, you pay nothing — every format here is a free download. One last tip: open your pdf in a desktop reader rather than in a browser tab, because browser viewers sometimes drop the interactive fields you need.
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
Submit the completed form through the channel not stated or your local guidance specifies. Save a copy for yourself before it leaves your hands, whether that means a scan, a photograph or a duplicate file.
When DD Form 3043 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 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?