Information Collection

Statement of Personal Injury: Possible Third Party Liability

IC 5566 under ICR 202509-0720-001 · OMB 0720-0003.

Documents and Forms

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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD2527				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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
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.

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