[Federal Register Volume 75, Number 189 (Thursday, September 30, 2010)]
[Notices]
[Pages 60416-60417]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-24529]
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DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID DoD-2010-HA-0131]
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 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 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 November
29, 2010.
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: Federal Docket Management System Office, 1160
Defense Pentagon, Room 3C843, Washington, DC 20301-1160.
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.
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 TRICARE Management
Activity, Office of General Counsel, 61401 E. Centretech Parkway, Attn:
Michael Bibbo, Aurora, CO 80011, or call TRICARE Management Activity,
Office of General Counsel, at (303) 676-3705.
Title; Associated Form; and OMB Number: Statement of Personal
Injury--Possible Third Party Liability, TRICARE Management Activity; DD
Form 2527; OMB Control 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: 56,100.
Number of Respondents: 224,399.
Responses per Respondent: 1.
Average Burden per Response: 15 minutes.
Frequency: On occasion.
SUPPLEMENTARY INFORMATION:
Summary of Information Collection
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
[[Page 60417]]
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: September 17, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-24529 Filed 9-29-10; 8:45 am]
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