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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.