Information Collection Request

Environmental Health Specialists Network (EHS-NET) Program

ICR 201109-0920-005 · OMB 0920-0792 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Food Allergen Study Form New Available
EHS-Net Listeria Retail Deli Study Form and Instruction New Available
Supporting Statement Part B- EHS-Net 1-23-2012.doc Supporting Statement B Uploaded 2012-01-23 Available
Attachment 6- Example of EHS-Net Data Collection Instrument- Recruiting Screener.doc Supplementary Document Uploaded 2011-09-22 Available
Attachment 3- Example of EHS-Net Data Collection Instrument- Interview.doc Supplementary Document Uploaded 2011-09-22 Available
Attachment 5- Example of EHS-Net Data Collection Informed Consent.doc Supplementary Document Uploaded 2011-09-15 Available
Attachment 4- Example of EHS-Net Data Collection CDC IRB Determination .doc Supplementary Document Uploaded 2011-09-15 Available
Attachment 2- EHS-Net Revision 60 Day FRN.pdf Supplementary Document Uploaded 2011-09-15 Available
Attachment 1- Regulation authorizing data collection.doc Supplementary Document Uploaded 2011-09-15 Available
Supporting Statement Part A- EHS-Net 1-23-2012.doc Supporting Statement A Uploaded 2012-01-23 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
208783 Food Allergen Study Form New
204612 EHS-Net Listeria Retail Deli Study Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2015 36 Months From Approved 02/29/2012
31,473 0 10,375
7,407 0 15,563
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Food Allergen Study none, none, none, none Manager Recruitment ,   Manager Interview ,   Worker Interview ,   Server Interview
EHS-Net Listeria Retail Deli Study none, none, none, none, none Manager Consent and Interview ,   Manager Survey ,   Manager Recruitment Script ,   Worker Recruitment Script ,   Worker Interview

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 31,473 10,375 0 21,098 0 0
Annual Time Burden (Hours) 7,407 15,563 0 -8,156 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No