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Submission for OMB Review; Comment Request

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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.


Consideration will be given to all comments received by September 12, 2016.

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Fred Licari, 571-372-0493.

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Title, Associated Form and OMB Number: Exchange Accident/Incident Reports; Exchange Form 3900-017, “Statements”, OMB Control Number: 0702-XXXX.

Type of Request: In existence without OMB Control Number.

Number of Respondents: 4854.

Responses per Respondent: 1.

Annual Responses: 4854.

Average Burden per Response: 60 minutes.

Annual Burden Hours: 4854 hours.

Needs and Uses: The information collection requirement is necessary to record incidents such as accidents, mishaps, fires, thefts or any issue involving government property. This collection insures the Exchange has the necessary information regarding injuries and illnesses in order to administer and follow-up on medical treatment and payment of claims. Collection assists the Exchange in recouping damages, correcting deficiencies, initiating appropriate disciplinary action(s), filing insurance and workers' compensation required documents.

Affected Public: Individuals or Households and Federal Government.

Frequency: On occasion.

Respondent's Obligation: Voluntary.

OMB Desk Officer: Ms. Jasmeet Seehra.

Comments and recommendations on the proposed information collection should be emailed to Ms. Jasmeet Seehra, DoD Desk Officer, at Please identify the proposed information collection by DoD Desk Officer and the Docket ID number and title of the information collection.

You may also submit comments and recommendations, identified by Docket ID number and title, by the following method:

Instructions: All submissions received must include the agency name, Docket ID number and title for this Federal Register document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing on the Internet at as they are received without change, including any personal identifiers or contact information.

DoD Clearance Officer: Mr. Frederick Licari.

Written requests for copies of the information collection proposal should be sent to Mr. Licari at WHS/ESD Directives Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100.

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Dated: August 8, 2016.

Aaron Siegel,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

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[FR Doc. 2016-19063 Filed 8-10-16; 8:45 am]