Information Collection

Statement of Personal Injury: Possible Third Party Liability

IC 5566 under ICR 202203-0720-005 · OMB 0720-0003.

⚠️ Notice: This information collection may be referencing outdated material.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 Form
DD Form 2527 Statement of Personal Injury - Possible Third Party Liab dd2527_20190212.pdf www.dtic.mil/whs/directives/infomgt/forms/formsprogram.htm Form
DD Form 2527 Statement of Personal Injury - Possible Third Party Liab dd2527_20190212.pdf www.dtic.mil/whs/directives/infomgt/forms/formsprogram.htm Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Personal Injury: Possible Third Party Liability	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	dd2527_20190212.pdf	http://www.dtic.mil/whs/directives/infomgt/forms/formsprogram.htm	Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: Medical/Dental Claim History Files	FR Citation: 78 FR 69076

Number of Respondents: 188,090	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	188,090	0	188,090
Annual IC Time Burden (Hours)	47,023	0	47,023
Annual IC Cost Burden (Dollars)	432,607	31,975	400,632

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.