Food Allergen Study

Environmental Health Specialists Network (EHS-NET) Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Food Allergen Study Form
Manager Recruitment Att 8- Mgr Rcrtg Script 9-24-2013.docx Form
Manager Interview Att 3- Mgr Informed Consent and Interview 9-23-2013.docx Form
Worker Interview Att 4- Worker Rcrtg Script Informed Consent and Interview 9-23-2103.docx Form
Server Interview Att 5- Server Rcrtg Script Informed Consent and Interview 9-23-2013.docx Form
EHS-Net Food Allergen Study Spprtng Statemnt A.DOC Supporting Statement A IC Document
EHS-Net Food Allergen Study Spprtng Statemnt B.DOC Supporting Statement B IC Document
Att 1- EHS-Net Industry Partners.doc 1 - EHS-Net Partners IC Document
Att 2- EHS-Net Publications.doc 2 - EHS-Net Publications IC Document
Att 6- Rstrnt Environ Obsrvtn.docx 6 - Environmental Observation IC Document
Att 7- Research Determination.pdf 7 - Research Determination IC Document

Information Collection (IC) Details

IC Title:	Food Allergen 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	Att 8- Mgr Rcrtg Script 9-24-2013.docx	No	No	Paper Only
Form	none	Manager Interview	Att 3- Mgr Informed Consent and Interview 9-23-2013.docx	No	No	Paper Only
Form	none	Worker Interview	Att 4- Worker Rcrtg Script Informed Consent and Interview 9-23-2103.docx	No	No	Paper Only
Form	none	Server Interview	Att 5- Server Rcrtg Script Informed Consent and Interview 9-23-2013.docx	No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,329	Number of Respondents for Small Entity: 0

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	1,329	0	0	0	0	0
Annual IC Time Burden (Hours)	242	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 Food Allergen Study Spprtng Statemnt A.DOC	09/24/2013
Supporting Statement B	EHS-Net Food Allergen Study Spprtng Statemnt B.DOC	09/24/2013
1 - EHS-Net Partners	Att 1- EHS-Net Industry Partners.doc	09/24/2013
2 - EHS-Net Publications	Att 2- EHS-Net Publications.doc	09/24/2013
6 - Environmental Observation	Att 6- Rstrnt Environ Obsrvtn.docx	09/24/2013
7 - Research Determination	Att 7- Research Determination.pdf	09/24/2013

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