Information Collection

EHS-Net Listeria Retail Deli Study

IC 204612 under ICR 201109-0920-005 · OMB 0920-0792.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0792 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
EHS-Net Listeria Retail Deli Study	Form and Instruction
Manager Consent and Interview Att. 4-EHS-Net Listeria-Manager Inf Cnsnt Intrvw 20121024.doc	Form and Instruction
Manager Survey Att. 5-EHS-Net Listeria-Manager Survey 20121024.doc	Form
Manager Recruitment Script Att. 11-EHS-Net Listeria-Manager Tel Recruit Scrpt 20121024.doc	Form and Instruction
Worker Recruitment Script Att. 6-EHS-Net Listeria-Worker Recruit Scrpt Inf Cnsnt 20121024.doc	Form and Instruction
Worker Interview Att. 7-EHS-Net Listeria-Worker Interview 20121024.doc	Form and Instruction
EHS-Net Listeria Supporting Statement A- 20121024.doc Supporting Statement A	IC Document
EHS-Net Listeria Supporting Statement B 20121024.doc Supporting Statement B	IC Document
Att. 2-EHS-Net Listeria-Industry Partners 20121024.doc Att 2- Industry Partners	IC Document
Att. 3-EHS-Net Publications 20121024.doc Att 3 - Publications	IC Document
Att. 8-EHS-Net Listeria-Structured Notational Obs 20121024.doc Att 8 - Observations	IC Document
Att. 9- EHS-Net Listeria Interagency Agreement 20121024.pdf Att 9 - Interagency Agreement	IC Document
Att. 10-EHS-Net Listeria-Research Partners 20121024.doc Att 10 - Research Partners	IC Document
Att. 12-EHS-Net Listeria-Data Cllctn Instrctn Manual 20121024.doc Att 12 - Data Collection Manual	IC Document
EHS-Net_Listeria_Supporting_Statement_B_11052012_REVISED.doc REVISED Supporting Statement B	IC Document
EHS-Net_Listeria_Supporting_Statement_A_11052012_REVISED.doc REVISED Supporting Statement A	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

EHS-Net Listeria Retail Deli Study

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Manager Consent and Interview	Att. 4-EHS-Net Listeria-Manager Inf Cnsnt Intrvw 20121024.doc	No	No	Paper Only
Form	none	Manager Survey	Att. 5-EHS-Net Listeria-Manager Survey 20121024.doc	No	No	Paper Only
Form and Instruction	none	Manager Recruitment Script	Att. 11-EHS-Net Listeria-Manager Tel Recruit Scrpt 20121024.doc	No	No	Paper Only
Form and Instruction	none	Worker Recruitment Script	Att. 6-EHS-Net Listeria-Worker Recruit Scrpt Inf Cnsnt 20121024.doc	No	No	Paper Only
Form and Instruction	none	Worker Interview	Att. 7-EHS-Net Listeria-Worker Interview 20121024.doc	No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,663

Number of Respondents for Small Entity: 460

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	1,663	0	0	0	0	0
Annual IC Time Burden (Hours)	249	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	EHS-Net Listeria Supporting Statement A- 20121024.doc	10/24/2012
Supporting Statement B	EHS-Net Listeria Supporting Statement B 20121024.doc	10/24/2012
Att 2- Industry Partners	Att. 2-EHS-Net Listeria-Industry Partners 20121024.doc	10/24/2012
Att 3 - Publications	Att. 3-EHS-Net Publications 20121024.doc	10/24/2012
Att 8 - Observations	Att. 8-EHS-Net Listeria-Structured Notational Obs 20121024.doc	10/24/2012
Att 9 - Interagency Agreement	Att. 9- EHS-Net Listeria Interagency Agreement 20121024.pdf	10/24/2012
Att 10 - Research Partners	Att. 10-EHS-Net Listeria-Research Partners 20121024.doc	10/24/2012
Att 12 - Data Collection Manual	Att. 12-EHS-Net Listeria-Data Cllctn Instrctn Manual 20121024.doc	10/24/2012
REVISED Supporting Statement B	EHS-Net_Listeria_Supporting_Statement_B_11052012_REVISED.doc	11/05/2012
REVISED Supporting Statement A	EHS-Net_Listeria_Supporting_Statement_A_11052012_REVISED.doc	11/05/2012

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