[Federal Register Volume 62, Number 86 (Monday, May 5, 1997)]
[Notices]
[Pages 24425-24426]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-11596]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Proposed Collection; Comment Request

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

ACTION: Notice.

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    In accordance with Section 3506(c)(2)(A) of the Paperwork Reduction 
Act of 1995, the Office of the Assistant Secretary of Defense for 
Health Affairs announces the proposed extension of a public information 
collection and seeks public comment on the provisions thereof. Comments 
are invited on: (a) Whether the proposed extension of 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 
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 July 7, 
1997.

ADDRESSES: Written comments and recommendations on the information 
collection should be sent to TRICARE Support Office, Office of General 
Counsel, US Army Garrison, Fitzsimons, Attn: Robert Shepherd, Aurora, 
CO 80045.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection, please write to the above address or 
call TRICARE Support Office, Office of General Counsel at (303) 361-
1193.
    Title Associated with Form, and OMB Number: Statement of Personal 
Injury--Possible Third Party Liability Champus, DD Form 2527, OMB 
Number 0720-0003.
    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 household, Federal government.
    Annual Burden Hours: 17,300.
    Number of Respondents: 29,500.
    Responses per Respondent: 1.
    Average Burden per Response: 35 minutes.
    Frequency: On occasion, only when a beneficiary is insured under 
circumstances creating possible liability in a third party.

SUPPLEMENTARY INFORMATION:

Summary of Information Collection

    The Federal Medical Care Recovery Act, 42 USC 2651-2653 as 
implemented by Executive Order No. 11060 and 28 CFR 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 some 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 CHAMPUS benefits is identified as involving 
possible third party liability and the information is not submitted 
with the claim, the TRICARE/CHAMPUS 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.

[[Page 24426]]

    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.
    Section 2 of the Form allows the injured beneficiary to explain in 
his or her own words how the injury occurred. This allows the 
beneficiary to explain that he or she was not injured in an accident or 
that no third party was responsible. If either of these conditions 
exist, the beneficiary does not have to complete the rest of the form.
    Section 3 of the Form is used to collect information about 
accidents that do not involve motor vehicles. Information such as 
location, time, date, property owner's name and address and the names 
and addresses of persons involved or witnesses is collected in this 
section of the form. Other information relating to police 
investigations, other injured family members, whether the accident was 
work related and insurance coverage is also collected.
    Section 4 of the Form is used to collect information about motor 
vehicle accidents. Most of the investigations for possible third party 
liability involve motor vehicle accidents. A beneficiary must attach a 
copy of the official police report to the form. Additional information 
not usually included in police reports is entered in Section 4, 
including information about insurance coverage of the parties, and 
whether the accident was work related is collected.
    Section 5 of the Form is used for miscellaneous information such as 
possible medical treatment in 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.
    Section 6 of the Form contains the certification, date and 
signature of the beneficiary (or a designee).

    Dated: April 29, 1997.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-11596 Filed 5-2-97; 8:45 am]
BILLING CODE 5000-04-M