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Statement Of Personal Injury - Possible Third Party Liability - Champus/champva

IC 108639 under ICR 199012-0704-002 · OMB 0704-0090.

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STATEMENT OF PERSONAL INJURY - POSSIBLE THIRD PARTY LIABILITY - CHAMPUS/CHAMPVA
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DD FORM 2527 No No


    

30,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30,000 0 0 0 0 30,000
Annual IC Time Burden (Hours) 17,000 0 0 0 0 17,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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