[Federal Register Volume 64, Number 61 (Wednesday, March 31, 1999)]
[Notices]
[Page 15352]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-7846]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Submission for OMB Review; Comment Request

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, 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 
filed in 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. 99-7846 Filed 3-30-99; 8:45 am]
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