Information Collection

Post-Wave Tracking Survey

IC 203881 under ICR 201208-0583-002 · OMB 0583-0157.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FoodSafety_AdCouncil_TrackingStudy_Rev 4-16-12 ACCULTURATION SCREENER - HISPANIC TRANSLATION.docx	Other-screener
FoodSafety_AdCouncil_TrackingStudy_Rev 4-16-12 QUESTIONNAIRE - ENGLISH.docx	Other-Questionnaire
FoodSafety_AdCouncil_TrackingStudy_Rev 4-16-12 QUESTIONNAIRE - HISPANIC TRANSLATION.docx	Other-questionnaire
FoodSafety_AdCouncil_TrackingStudy_Rev 4-16-12 ACCULTURATION SCREENER - ENGLISH.docx	Other-screener
FoodSafety_AdCouncil_Tracking_2012_Questionnaire_English_FINAL.docx	Other-Questionnaire
FoodSafety_AdCouncil_Tracking_2012_Questionnaire_Spanish_FINAL.docx	Other-Questionnaire

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-screener	FoodSafety_AdCouncil_TrackingStudy_Rev 4-16-12 ACCULTURATION SCREENER - HISPANIC TRANSLATION.docx	Yes	No	Paper Only
Other-Questionnaire	FoodSafety_AdCouncil_TrackingStudy_Rev 4-16-12 QUESTIONNAIRE - ENGLISH.docx	Yes	No	Paper Only
Other-questionnaire	FoodSafety_AdCouncil_TrackingStudy_Rev 4-16-12 QUESTIONNAIRE - HISPANIC TRANSLATION.docx	Yes	No	Paper Only
Other-screener	FoodSafety_AdCouncil_TrackingStudy_Rev 4-16-12 ACCULTURATION SCREENER - ENGLISH.docx	Yes	No	Paper Only
Other-Questionnaire	FoodSafety_AdCouncil_Tracking_2012_Questionnaire_English_FINAL.docx	Yes	No	Paper Only
Other-Questionnaire	FoodSafety_AdCouncil_Tracking_2012_Questionnaire_Spanish_FINAL.docx	Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

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	1,200	1,200
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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