Statement of Personal Injury: Possible Third Party Liability

Documents and Forms

Document Name Document Type
Form DD2527 Statement of Personal Injury: Possible Third Party Liability Form and Instruction
DD2527 Statement of Personal Injury: Possible Third Party Liabi dd2527 Unlocked - edits 20250716 (wait for omb update).pdf Form and Instruction

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 and Instruction	DD2527	Statement of Personal Injury: Possible Third Party Liability	dd2527 Unlocked - edits 20250716 (wait for omb update).pdf		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: 90 FR 34258

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	188,090	188,090
Annual IC Time Burden (Hours)	47,023	47,023
Annual IC Cost Burden (Dollars)	1,535,755	1,535,755

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.