[Federal Register Volume 63, Number 219 (Friday, November 13, 1998)]
[Notices]
[Pages 63454-63455]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-30310]
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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, DoD.
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 January 12,
1998.
ADDRESSES: Written comments and recommendations on the information
collection should be sent to Tricare Management Activity, Office of
General Counsel, 16401 E. Centretech Parkway, Attn: Robert Shepherd,
Aurora, CO 80011.
FOR FURTHER INFORMATION CONTACT:
To request more information on this proposed information collection,
please write to the above address or call Tricare Management Activity,
Office of General Counsel at (303) 676-3703.
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 U.S.C. 2651-2653 as
implemented by Executive Order No. 11060 and 28 C.F.R. 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, 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' claim. When appropriate, the information is
[[Page 63455]]
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.
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: November 6, 1998.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 98-30310 Filed 11-12-98; 8:45 am]
BILLING CODE 5000-04-M
