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

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]

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