94-19552. Public Information Collection Requirement Submitted to the Office of Management and Budget (OMB) for Review

[Federal Register Volume 59, Number 154 (Thursday, August 11, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-19552]


[[Page Unknown]]

[Federal Register: August 11, 1994]


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DEPARTMENT OF DEFENSE
 

Public Information Collection Requirement Submitted to the Office 
of Management and Budget (OMB) for Review

ACTION: Notice.

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    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).

Title, Applicable Form, And OMB Control Number: Statement of Personal 
Injury--Possible Third Party Liability--CHAMPUS; DD Form 2527; OMB 
Control Number 0720-0003
Type of Request: EXPEDITED PROCESSING--Approval date requested: 30 days 
following publication in the Federal Register
Number of Respondents: 32,500
Responses Per Respondent: 1
Annual Responses: 32,500
Average Burden Per Response: 13.8 minutes
Annual Burden Hours: 7,475
Needs and Uses: The Statement of Personal Injury--Possible Third Party 
Liability Form is completed by CHAMPUS beneficiaries suffering from 
personal injuries and receiving medical care at Government expense. The 
information collected hereby is utilized in the assertion of the 
Government's right to recovery under the Federal Medical Care Recovery 
Act. It is used in the evaluation and processing of recovery claims.
Affected Public: Individuals or households, Federal agencies or 
employees
Frequency: On occasion
Respondent's Obligation: Required to obtain or retain a benefit
OMB Desk Officer: Ms. Shannah Koss
    Written comments and recommendations on the proposed information 
collection should be sent to Ms. Koss at the Office of Management and 
Budget, Desk Officer for DoD, Room 10235, New Executive Office 
Building, Washington, DC 20503
DoD Clearance Officer: Mr. William P. Pearce.
    Written requests for copies of the information collection proposal 
should be sent to Mr. Pearce, WHS/DIOR, 1215 Jefferson Davis Highway, 
Suite 1204, Arlington, VA 22202-4302

    Dated: August 5, 1994.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.

BILLING CODE 5000-04-M

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[FR Doc. 94-19552 Filed 8-10-94; 8:45 am]
BILLING CODE 5000-04-C