The Department of Defense has submitted to OMB for clearance, the following proposal for collection of information under the provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35).
Consideration will be given to all comments received by April 29, 2004.
Title, Form, and OMB Number: Statement of Personal Injury—Possible Third Party Liability CHAMPUS; DD Form 2527; OMB Number 0720-0003.
Type of Request: Reinstatement.
Number of Respondents: 133,000.
Responses Per Respondent: 1.
Annual Responses: 133,000.
Average Burden Per Response: 15 minutes.
Annual Burden Hours: 33,250.
Needs and Uses: This information collection is completed by 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.
Frequency: On Occasion.
Respondent's Obligation: Required to Obtain or Retain Benefits.
OMB Desk Officer: Mr. John Kraemer.
Written comments and recommendations on the proposed information collection should be sent to Mr. Kraemer at the Office of Management and Budget, Desk Officer for DoD Health Affairs, Room 10236, New Executive Office Building, Washington, DC 20503.
DoD Clearance Officer: Mr. Robert Cushing.
Written requests for copies of the information collection proposal should be sent to Mr. Cushing, WHS/ESCD/Information Management Division, 1225 Jefferson Davis Highway, Suite 504, Arlington, VA 22202-4326.Start Signature
Dated: March 24, 2004.
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 04-7047 Filed 3-29-04; 8:45 am]
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