[Federal Register Volume 64, Number 3 (Wednesday, January 6, 1999)] [Notices] [Pages 862-863] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 99-212] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF DEFENSE Department of the Air Force Agency Information Collection Activities: Proposed Collection AGENCY: Air Force Medical Operations Agency, DoD. In compliance with Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Air Force Medical Operations Agency, Clinical Quality Management Division, AFMOA/SGOC, announces the proposed reinstatement and the initiation 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. [[Page 863]] DATES: Consideration will be given to all comments received on or before March 8, 1999. ADDRESSES: Written comments and recommendations on the proposed information collection should be sent to 110 Luke Avenue, Room 405, Bolling AFB, DC 20332-7050, ATTN: Maj Lynn Poppino. 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 the above address, or call AFMOA/SGOC at (202) 767-4077. Title, Associated Forms, and OMB Number: Medical Treatment Facility Incident Statement, AF Form 765, OMB Number 0701-0135 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 fact. If the information is not collected as needed, MTFs will lose the opportunity to identify potential risks in the facilities. Possible outcomes for failure to identify risks are medical malpractice, patient injury or death, unnecessary financial expenditure, and poor public perception of the MTF. Affected Public: All individuals in Air Force Medical Treatment Facilities, to include patients, visitors, contractors, civilian, and military staff members. Annual Burden Hours: 1,056. Number of Respondents: 13,200. Responses per Respondent: 1. Average Burden per Respondent: 5 minutes. Frequency: In the event of an incident resulting in injury or possible injury. SUPPLEMENTARY INFORMATION: Summary of Information Collection. Carolyn A. Lunsford, Air Force Federal Register Liaison Officer. [FR Doc. 99-212 Filed 1-5-99; 8:45 am] BILLING CODE 5001-05-P