EHS-Net Food and Safety Practices & Beliefs 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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.