Information Collection

FY13 Pilot – Completion of Sections 1 and 3 – Fast Food Facility Type

IC 204848 under ICR 201211-0910-005 · OMB 0910-0744.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0744 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DATA COLLECTION FORM FOODBORNE ILLNESS 5-8-13.doc	Other-SURVEY
MARKING INSTRUCTIONS 5-8-13.doc	Other-Survey

IC Title:

FY13 Pilot â Completion of Sections 1 and 3 â Fast Food Facility Type

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 5.10(a)(2)and(4)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-SURVEY			DATA COLLECTION FORM FOODBORNE ILLNESS 5-8-13.doc		No		Paper Only
Other-Survey			MARKING INSTRUCTIONS 5-8-13.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 44

Number of Respondents for Small Entity: 0

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 Agency Discretion
Annual Number of Responses for this IC	44	44
Annual IC Time Burden (Hours)	53	53
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.