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[Federal Register Volume 80, Number 78 (Thursday, April 23, 2015)]
[Notices]
[Pages 22719-22720]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-09434]

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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID DoD-2015-HA-0036]

Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense for Health 
Affairs, DoD.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, the 
Office of the Assistant Secretary of Defense for Health Affairs 
announces a proposed public information collection and seeks public 
comment on the provisions thereof. Comments are invited on: (a) Whether 
the proposed collection of information is necessary for the proper 
performance of the functions of the agency, including whether the 
information shall have practical utility; (b) the accuracy of the 
agency's estimate of the burden of the proposed information collection; 
(c) ways to enhance the quality, utility, and clarity of the 
information to be collected; and (d) ways to minimize the burden of the 
information collection on respondents, including through the use of 
automated collection techniques or other forms of information 
technology.

DATES: Consideration will be given to all comments received by June 22, 
2015.

ADDRESSES: You may submit comments, identified by docket number and 
title, by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Department of Defense, Office of the Deputy Chief 
Management Officer, Directorate of Oversight and Compliance, Regulatory 
and Audit Matters Office, 9010 Defense Pentagon, Washington, DC 20301-
9010.
    Instructions: All submissions received must include the agency 
name, docket number and title for this Federal Register document. The 
general policy for comments and other submissions from members of the 
public is to make these submissions available for public viewing on the 
Internet at http://www.regulations.gov as they are received without 
change, including any personal identifiers or contact information.
    Any associated form(s) for this collection may be located within 
this same electronic docket and downloaded for review/testing. Follow 
the instructions at http://www.regulations.gov for submitting comments. 
Please submit comments on any given form identified by docket number, 
form number, and title.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection or to obtain a copy of the proposal and 
associated collection instruments, please write to the Defense Health 
Agency, Office of General Counsel, 61401 E. Centretech Parkway, ATTN: 
Bridget Ewings, Aurora, CO 80011, or call Defense Health Agency, Office 
of General Counsel, at (303) 676-3705.

SUPPLEMENTARY INFORMATION:
    Title; Associated Form; and OMB Number: Statement of Personal 
Injury--

[[Page 22720]]

Possible Third Party Liability, Defense Health Agency; DD Form 2527; 
OMB Number 0720-0003.
    Needs and Uses: This information collection is completed by TRICARE 
(formerly CHAMPUS) beneficiaries suffering from personal injuries and 
receiving medical care at Government expense. The information is 
necessary in the assertion of the Government's right to recovery under 
the Federal Medical Care Recovery Act. The data is used in the 
evaluation and processing of these claims.
    Affected Public: Individuals or Households; Federal Government.
    Annual Burden Hours: 47,023.
    Number of Respondents: 188,090.
    Responses per Respondent: 1.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.
    The Federal Medical Recovery Act, 42 U.S.C. 2651-2653 as 
implemented by Executive Order No. 11060 and 28 CFR part 43 provides 
for recovery of the reasonable value of medical care provided by the 
United States to a person who is injured or suffers a disease under 
circumstances creating tort liability in a third person. DD Form 2527 
is required for investigating and asserting claims in favor of the 
United States arising out of such incidents.
    When a claim for TRICARE benefits is identified as involving 
possible third party liability and the information is not submitted 
with the claim, the TRICARE contractor requests that the injured party 
(or a designee) complete DD Form 2527. To protect the interests of the 
Government, the contractor suspends claims processing until the 
requested third party liability information is received. The contractor 
conducts a preliminary evaluation based upon the collection of 
information and refers the case to a designated appropriate legal 
officer of the Uniformed Services. The responsible Uniformed Services 
legal officer uses the information as a basis for asserting and 
settling the Government's claim. When appropriate, the information is 
forwarded to the Department of Justice as the basis for litigation.
    Section 1 of the Form is used to collect general information, such 
as name, address and telephone numbers about the military sponsor and 
the injured beneficiary and the date, time and location where the 
injured occurred.
    Section 2 of the Form is used to collect information about 
accidental injuries. Most of the investigations for third party 
liability involve motor vehicle accidents. Information about insurance 
coverage for the parties involved in the accident is collected. Section 
2 of the Form is also used to collect information about accidents not 
involving motor vehicles. Information such as the type of accident, the 
place where the injury occurred, the name of the property owner where 
the injury occurred and cause of the injury is collected. The name and 
address of the employer is collected when the injury was work related.
    Section 3 of the Form is used for miscellaneous information such as 
possible medical treatment at a Government hospital, the name and 
address of the beneficiary's attorney, and information regarding any 
possible releases or settlements with another party to the accident. It 
also contains the certification, date and signature of the beneficiary 
(or a designee).

    Dated: April 16, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2015-09434 Filed 4-22-15; 8:45 am]
 BILLING CODE 5001-06-P
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