Agency information collection activities: Submission for OMB review; comment request,

[Federal Register: March 31, 1999 (Volume 64, Number 61)]

[Notices]

[Page 15352]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr31mr99-43]

DEPARTMENT OF DEFENSE

Office of the Secretary

Submission for OMB Review; Comment Request

ACTION: Notice.

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, Associated Form, and OMB Number: Medical Treatment Facility Incident Statement; AF Form 765; OMB Number 0701-0135.

Type of Request: Reinstatement.

Number of Respondents: 1.

Annual Responses: 13,200.

Annual Burden Per Response: 5 minutes.

Annual Burden Hours: 1,056.

Needs and Uses: The form is used by respondents (hospital employees, including non-governmental personnel and contractors) to report specific incidents that may have resulted in injury. It is not filedin a patient's record, but is kept by the medical treatment facility (MTF) Quality Service/Risk Manager until appropriate actions are completed to analyze the incident and determine whether corrective action is necessary to avoid repeat incidents. After completion and corrective action, if required, the form is retained for one year and then destroyed. Information recorded on the form is concise statements of facts. If the information is not collected as needed, MTFs will lose the opportunity to identify potential risks in the facilities.

Affected Public: Individuals or households.

Frequency: On Occasion.

Respondent's Obligation: Voluntary.

OMB Desk Officer: Mr. Edward C. Springer.

Written comments on recommendations on the proposed information collection should be sent to Mr. Springer at the Office of Management and Budget, Desk Officer for DoD, Room 10236, New Executive Office Building, Washington, DC 20503.

DOD Clearance Officer: Mr. Robert Cushing.

Written requests copies of the information collection proposal should be sent to Mr. Cushing, WHS/DIOR, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 2202-4302.

Dated: March 24, 1998. Patricia L. Toppings, Alternate OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 99-7846Filed3-30-99; 8:45 am]

BILLING CODE 5001-10-M