Information Collection

Stakeholder Interviews for Break the Chain Retailer Education Campaign

IC 200903 under ICR 201009-0910-003 · OMB 0910-0674.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0674 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Doc04_Appendix B.pdf	Other-Appendix B with Survey
Doc05_Appendix C.pdf	Other-Appendix C with Survey
Break the Chain OMB justification Memo.doc Break the Chain OMB justification Memo	IC Document

IC Title:

Stakeholder Interviews for Break the Chain Retailer Education Campaign

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix B with Survey			Doc04_Appendix B.pdf		Yes	No	Printable Only
Other-Appendix C with Survey			Doc05_Appendix C.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	26	26
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Break the Chain OMB justification Memo	Break the Chain OMB justification Memo.doc	01/24/2012

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