Information Collection

EHS-Net Food and Safety Practices & Beliefs Study

IC 228125 under ICR 201504-0920-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Food and Safety Practices & Beliefs Study	Form and Instruction
Telephone Manager Recruiting Script Att 4- Tplhn Mgr Rcrtg Scipt.docx	Form and Instruction
Manager Informed Consent and Interview Att 5 -Mgr Infrmd Cnsnt Intrvw Frm.docx	Form and Instruction
Manager Interview Guide Att 6 - Mgr Intrvw Mrkng Guide.docx	Form and Instruction
Food Worker Informed Consent and Written Survey Att 8 -Food Wkr Infrmd Cnsnt Srvy Frm.docx	Form and Instruction
Food Workere Informed Consent and Electronic Survey Att 9 - Foodwkr Infrmd Cnsnt Elctrnc Srvy Scrn Shts.pdf	Form and Instruction
Restaurant Environment Observation Form Att 10 - RestEnvObsrvtnFormA.docx	Form and Instruction
EHS-Net FSC_SSA_Clean.docx Supportingt Statement A	IC Document
EHS-Net FSC_SSB_Clean.docx Supporting Statement B	IC Document
Att 1- Auth Legislation.doc Authorizing Legislation	IC Document
Att 2- EHS-Net Industry Partners .doc EHS-Net Industry Partners	IC Document
Att 3 -EHS-Net Publications.docx EHS-Net Publications	IC Document
Att 7- Food Wrkr Rcrtmnt Flyr.docx Food Worker Recruitment Flyer	IC Document
Att 11- RDFFoodSftyPrctcsandBlf-OSSign.pdf Research Determination	IC Document

IC Title:

EHS-Net Food and Safety Practices & Beliefs Study

Agency IC Tracking Number:

0920-0792-17AYZ

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Telephone Manager Recruiting Script	Att 4- Tplhn Mgr Rcrtg Scipt.docx		No		Paper Only
Form and Instruction	NA	Manager Informed Consent and Interview	Att 5 -Mgr Infrmd Cnsnt Intrvw Frm.docx	NA	No		Paper Only
Form and Instruction	NA	Manager Interview Guide	Att 6 - Mgr Intrvw Mrkng Guide.docx	NA	No		Paper Only
Form and Instruction	NA	Food Worker Informed Consent and Written Survey	Att 8 -Food Wkr Infrmd Cnsnt Srvy Frm.docx	NA	No		Paper Only
Form and Instruction	NA	Food Workere Informed Consent and Electronic Survey	Att 9 - Foodwkr Infrmd Cnsnt Elctrnc Srvy Scrn Shts.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Restaurant Environment Observation Form	Att 10 - RestEnvObsrvtnFormA.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,596

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,596	4,596
Annual IC Time Burden (Hours)	856	856
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supportingt Statement A	EHS-Net FSC_SSA_Clean.docx	08/30/2017
Supporting Statement B	EHS-Net FSC_SSB_Clean.docx	08/30/2017
Authorizing Legislation	Att 1- Auth Legislation.doc	08/30/2017
EHS-Net Industry Partners	Att 2- EHS-Net Industry Partners .doc	08/30/2017
EHS-Net Publications	Att 3 -EHS-Net Publications.docx	08/30/2017
Food Worker Recruitment Flyer	Att 7- Food Wrkr Rcrtmnt Flyr.docx	08/31/2017
Research Determination	Att 11- RDFFoodSftyPrctcsandBlf-OSSign.pdf	08/31/2017

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