Form Information

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FORM NUMBER:

DD2494-1

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TITLE:

TRICARE - ACTIVE DUTY FAMILY MEMBER DENTAL PLAN (FMDP) ENROLLMENT ELECTION,

SUPPLEMENTAL

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EDITION DATE:

19950901

CANCELLATION DATE:

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AVAILABLE FILE FORMATS:

PLEASE NOTE:

Fillable Adobe:

PDF-Ext

If no hyperlink appears next to a format, the form is not available electronically.

Perform Pro:

To obtain hard copies of current forms not available in electronic format, please

Form Flow 2.0:

contact your own Military Service or DoD Component Forms Management

Form Flow 99:

Officer. Cancelled forms are not available in electronic formats. Click on link for

Other:

a list of Forms Management POCs.

Forms Management POCs

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REMARKS:

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ISSUANCES:

DODI 6015.23

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SPONSOR / POC:

HA

SUB-SPONSOR:

NUMBER OF PAGES:

2

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USERS*:

A N AF MC CG PHS

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PRESCRIBED OR ADOPTED?:

P

DISPOSITION:

S

FUNCTION CODE:

6015

FORM CONTROLLED:

MANDATORY PRINT SPECIFICATIONS:

N

RCS:

1453

IRCN:

OMB:

PRIVACY ACT IMPLICATIONS:

Y

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* All revisions and/or cancellations must be coordinated through these USERS.

DISPOSITION: S = Do NOT use previous edition. U = Use previous edition until supply is depleted.