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Agenda
Reg Review
ICR
View Information Collection (IC)
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
Federal Enterprise Architecture Business Reference Module
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 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
0
0
188,090
Annual IC Time Burden (Hours)
47,023
0
0
0
0
47,023
Annual IC Cost Burden (Dollars)
432,607
0
31,975
0
0
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.