Information Collection

Professional Services to Support Requirements Gathering Sessions for Safe Food Handling

IC 216568 under ICR 201505-0583-001 · OMB 0583-0166.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0527App B_Pre_Questionnaire_ENG_SPA_final.docx	Other-pre-questionnaire
0527App E_Screening Questionnaires_ENG_SPA_final.doc	Other-screening questionnaire
0527App C_Post_Questionnaire_ENG_SPA_Final.docx	Other-post-questionnaire
0527App A moderator guide_ENG_SPA_final.doc Moderator Guide	IC Document
0527App D_IRB Approval Form.doc IRB Approval Form	IC Document
0527App F_ Consent Form .docx Consent Form	IC Document
0527Appendix G- confirmation letter.doc Confirmation Letter	IC Document
Appendix_A.2_10_7_15.docx Participant Handouts	IC Document

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?	Electronic Capability
Other-pre-questionnaire	0527App B_Pre_Questionnaire_ENG_SPA_final.docx	No	Paper Only
Other-screening questionnaire	0527App E_Screening Questionnaires_ENG_SPA_final.doc	No	Paper Only
Other-post-questionnaire	0527App C_Post_Questionnaire_ENG_SPA_Final.docx	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	480	480
Annual IC Time Burden (Hours)	157	157
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Moderator Guide	0527App A moderator guide_ENG_SPA_final.doc	05/28/2015
IRB Approval Form	0527App D_IRB Approval Form.doc	05/28/2015
Consent Form	0527App F_ Consent Form .docx	05/28/2015
Confirmation Letter	0527Appendix G- confirmation letter.doc	05/28/2015
Participant Handouts	Appendix_A.2_10_7_15.docx	11/02/2015

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