Information Collection

Survey

IC 204882 under ICR 201405-0910-003 · OMB 0910-0747.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
whole grain survey.doc	Other-Survey
test graphics.pdf test graphics	IC Document

IC Title:

Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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			whole grain survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,700

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	Previously Approved
Annual Number of Responses for this IC	2,700	2,700
Annual IC Time Burden (Hours)	675	675
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
test graphics	test graphics.pdf	11/15/2012

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