Statement of Personal Injury - Possible Third Party Liability Champus

Statement of Personal Injury - Possible Third Party Liability Champus

OMB: 0720-0003

IC ID: 5566

Information Collection (IC) Details

View Information Collection (IC)

Statement of Personal Injury - Possible Third Party Liability Champus
 
No Modified
 
Required to Obtain or Retain Benefits
 
28 CFR 43

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DD Form 2527, 20150911 Statement of Personal Injury - Possible Third Party Liability dd2527_20150911.PDF http://www.dtic.mil/whs/directives/infomgt/forms/formsprogram.htm Yes No Fillable Printable

Defense and National Security Operational Defense

Medical/Dental Claim History Files  78 FR 69076

188,090 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 188,090 0 0 -36,309 224,399 0
Annual IC Time Burden (Hours) 47,023 0 0 -9,077 56,100 0
Annual IC Cost Burden (Dollars) 400,632 0 0 302,072 98,560 0

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