[Federal Register Volume 59, Number 46 (Wednesday, March 9, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-5333]


[[Page Unknown]]

[Federal Register: March 9, 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 and Applicable Form: Nutritional Assessment of Dietary 
Intake; Air Force Form 2572.
    Type of Request: Existing collection in use without an OMB control 
number.
    Number of Respondents: 12,000.
    Responses Per Respondent: 1.
    Annual Responses: 12,000.
    Average Burden Per Response: 15 minutes.
    Annual Burden Hours: 3,000.
    Needs and Uses: Air Force Form 2572 is used to record food intake 
on all inpatients and some out patients receiving therapeutic diets, 
and those receiving a regular diet when requested by the health care 
provider. The diet counselor analyzes the information, records the 
analysis on the reverse side of the form, writes a progress note to the 
physician and files the AF 2572 in the patient's medical record.
    Affected Public: Individuals or households; Federal agencies or 
employees.
    Frequency: On occasion.
    Respondent's Obligation: Voluntary.
    OMB Desk Officer: Mr. Edward C. Springer.
    Written comments and recommendations on the proposed information 
collection should be sent to Mr. Springer at the Office of Management 
and Budget, Desk Officer for DoD, room 3235, New Executive Office 
Building, Washington, DC 20503.
    DOD Clearance Officer: Mr. William Pearce.
    Written request 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: March 3, 1994.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 94-5333 Filed 3-8-94; 8:45 am]
BILLING CODE 5000-04-M