Information Collection

Food Worker Consent and Survey - Intervention Visit 1

IC 228960 under ICR 201711-0920-008 · OMB 0920-1227.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1227 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Food Worker Consent and Survey - Intervention Visit 1	Form
Food Worker Consent and Survey Att 7 Food Wrkr Infrmd Cnsnt and Srvy Frm.docx	Form

IC Title:

Food Worker Consent and Survey - Intervention Visit 1

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Food Worker Consent and Survey	Att 7 Food Wrkr Infrmd Cnsnt and Srvy Frm.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 270

Number of Respondents for Small Entity: 134

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	270	270
Annual IC Time Burden (Hours)	23	23
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.