OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Statement of Personal Injury: Possible Third Party Liability

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

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Statement of Personal Injury: Possible Third Party Liability
 
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 and Instruction DD2527 Statement of Personal Injury: Possible Third Party Liability dd2527 Unlocked - edits 20250716 (wait for omb update).pdf No   Fillable Printable

Defense and National Security Operational Defense

Medical/Dental Claim History Files  90 FR 34258

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 0 188,090 0 0 0
Annual IC Time Burden (Hours) 47,023 0 47,023 0 0 0
Annual IC Cost Burden (Dollars) 1,535,755 0 1,535,755 0 0 0

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