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Prime Travel Benefit

These forms are used to request travel orders and submit claims under the TRICARE Prime Travel Benefit. Some forms are used in all three regions while others are region-specific.

North Region Forms

Prime Travel Benefit Intake Form

If you have a civilian primary care manager, you’ll submit copies of your referral and/or authorization along with this form to begin authorization for using the TRICARE Prime Travel Benefit in the North Region. If you qualify, you’ll receive travel orders from the TRICARE Regional Office (TRO)-North. If you have questions, call the TRO-North at 1-703-588-1867 or 1-703-588-1869. Mail or fax the completed form along with a copy of your referral and/or authorization to the North Prime Travel Office.

Electronic Funds Transfer Authorization

Use this form to establish an electronic funds transfer so you can receive your reimbursement electronically. Once this form is submitted to the Prime Travel Office, you will not need to submit it again unless there is a change.

West Region Forms

Prime Travel Support Form

Submit this form with all other supporting documents to the TRICARE Regional Office (TRO)-West to get reimbursed under the Prime Travel Benefit.

Confirmation of Specialty Care Form

Print this form and take it with you to your appointment for the specialty care provider to complete. Please note that you must submit this form with all other supporting documents after the trip for reimbursement of your expenses to the TRO-West.

Active Duty Service Member/Government Employee NMA Memo

This form must be completed by command or appropriate agency official to authorize TDY travel reimbursement for the NMA (if NMA is on active duty or a federal employee).

Electronic Funds Transfer Authorization

Use this form to establish an electronic funds transfer so you can receive your reimbursement electronically. Once this form is submitted to the Prime Travel Office, you will not need to submit it again unless there is a change.

DD Forms for Submitting Travel Claims

Travel Voucher or Subvoucher (DD Form 1351-2)

Use this form to submit your actual expenses to get reimbursement through the TRICARE Prime Travel Benefit. Send the form along with all receipts and supporting documents to your region's Prime Travel Benefit Office.

Travel Voucher or Subvoucher Continuation Sheet (DD Form 1351-2c)

Use this as a continuation for the Travel Voucher or Subvoucher if you need it.

Statement of Actual Expenses (DD Form 1351-3)

Use this form to get reimbursement through the TRICARE Prime Travel Benefit. Send the form along with all receipts and supporting documents to your region's Prime Travel Benefit Office.

Prime Travel Benefit Office Addresses

North Region South Region  West Region 

TRICARE Regional Office
ATTN: Prime Travel
1700 North Moore Street, Suite 1200
Arlington, Virginia 22209

Fax: 1- 703-588-0634

TRO-South Prime Travel
7800 IH 10 West, Ste. 400
San Antonio, 78230

Fax: 1-210-292-8517

TRICARE Regional Office-West
Attn: Prime Travel
401 West A Street, Suite 2100
San Diego, CA 92101-7908

Fax: 1-619-231-4245

Last Updated 5/28/2014