# Agency Information Collection Activities: Proposed Collection

> Briefs, arguments, decisions, and more.

URL: https://www.frixlaw.com/law-library/documents/fr%3A99-212

## Record

- **Collection:** Federal Register
- **Document type:** Notice
- **Published:** January 6, 1999
- **Citation:** 64 FR 862

## Text

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

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A99-212. Public record. Not legal advice.