94-16191. Public Information Collection Requirement Submitted to the Office of Management and Budget (OMB) for Review

[Federal Register Volume 59, Number 127 (Tuesday, July 5, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-16191]


[[Page Unknown]]

[Federal Register: July 5, 1994]


-----------------------------------------------------------------------


DEPARTMENT OF DEFENSE
 

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

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 and Applicable Form: Medical Treatment Facility Incident 
Statement; Air Force Form 765.
    Type of Request: New collection.
    Number of Respondents: 13,200.
    Responses per Respondent: 1.
    Annual Responses: 13,200.
    Average Burden per Response: 5 minutes.
    Annual Burden Hours: 1,056.
    Needs and Uses: The Air Force Form 765, ``Medical Treatment 
Facility Incident Statement,'' is completed by hospital personnel on 
behalf of patients, who may be non-governmental personnel, to document 
adverse events or specific incidents inconsistent with routine medical 
treatment facility operations or patient care.
    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 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: June 29, 1994.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 94-16191 Filed 7-1-94; 8:45 am]
BILLING CODE 5000-04-M