Document Name Document Type
EHS-Net Kitchen Manager Certification Study Form
Manager Recruitment Screener Attachment 11- EHS-Net KMC Study Manager Telephone Recruiting Screener (2).doc Form
Manager Interview Attachment 3- EHS-Net KMC Study Data Collection Instrument- Manager Interview.doc Form
Manager survey Attachment 4- EHS-Net KMC Study Data Collection Instrument- Manager Survey.doc Form
Kitchen observation Attachment 5- EHS-Net KMC Study Data Collection Instrument- Kitchen Observation.doc Form
Worker interview Attachment 6- EHS-Net KMC Study Data Collection Instrument- Worker Interview.doc Form
Worker screener and consent Attachment 10- EHS-Net KMC Study Worker Recruiting Screener and Informed Consent.doc Form
EHS-Net KMC Study- Supporting Statement (Part A).doc Supporting statement A IC Document
Attachment 7- EHS-Net KMC Study Analysis Variables.docx Analysis variables IC Document
Attachment 8- EHS-Net KMC Study CDC IRB Determination .doc IRB approval IC Document
Attachment 9- EHS-Net KMC Study Manager Informed Consent.doc Manager consent IC Document
Summary of changes.doc Summary of changes IC Document
EHS-Net KMC Study- Supporting Statement (Part B) revised 6-22-02011.doc Supporting Statement Part B- revised IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EHS-Net Kitchen Manager Certification Study	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Manager Recruitment Screener	Attachment 11- EHS-Net KMC Study Manager Telephone Recruiting Screener (2).doc	No	No	Paper Only
Form	none	Manager Interview	Attachment 3- EHS-Net KMC Study Data Collection Instrument- Manager Interview.doc	No	No	Paper Only
Form	none	Manager survey	Attachment 4- EHS-Net KMC Study Data Collection Instrument- Manager Survey.doc	No	No	Paper Only
Form	none	Kitchen observation	Attachment 5- EHS-Net KMC Study Data Collection Instrument- Kitchen Observation.doc	No	No	Paper Only
Form	none	Worker interview	Attachment 6- EHS-Net KMC Study Data Collection Instrument- Worker Interview.doc	No	No	Paper Only
Form	none	Worker screener and consent	Attachment 10- EHS-Net KMC Study Worker Recruiting Screener and Informed Consent.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,038	Number of Respondents for Small Entity: 912

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	3,038	0	0	0	0	0
Annual IC Time Burden (Hours)	770	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting statement A	EHS-Net KMC Study- Supporting Statement (Part A).doc	03/30/2011
Analysis variables	Attachment 7- EHS-Net KMC Study Analysis Variables.docx	03/30/2011
IRB approval	Attachment 8- EHS-Net KMC Study CDC IRB Determination .doc	03/30/2011
Manager consent	Attachment 9- EHS-Net KMC Study Manager Informed Consent.doc	03/30/2011
Summary of changes	Summary of changes.doc	04/06/2011
Supporting Statement Part B- revised	EHS-Net KMC Study- Supporting Statement (Part B) revised 6-22-02011.doc	07/01/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

EHS-Net Kitchen Manager Certification Study