[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