Statement of Personal Injury - Possible Third Party Liability Champus

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0003 can be found here:

Documents and Forms

Document Name Document Type
Form DD Form 2527 Statement of Personal Injury - Possible Third Party Liability Champus Form
DD Form 2527 Statement of Personal Injury - Possible Third Party Liab dd2527.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Personal Injury - Possible Third Party Liability Champus	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 28 CFR 43

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 2527	Statement of Personal Injury - Possible Third Party Liability TRICARE Management Activity	dd2527.pdf		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 224,399	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	224,399	91,399	133,000
Annual IC Time Burden (Hours)	56,100	22,850	33,250
Annual IC Cost Burden (Dollars)	98,560	44,030	54,530

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.