Information Collection

Food Safety Survey: Survey

IC 190819 under ICR 201712-0910-002 · OMB 0910-0345.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0345 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A Questionnaire 11 25 14.doc	Other-Questionnaire
Attachement B 11 25 14.doc	Other-Letter to respondent
Attachment C 11 25 14.doc	Other-Non response letter
Attachment D 11 25 14.doc	Other-Non response questionnaire

IC Title:

Food Safety Survey: 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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire	Appendix A Questionnaire 11 25 14.doc	Yes	Yes	Fillable Fileable
Other-Letter to respondent	Attachement B 11 25 14.doc	No		Paper Only
Other-Non response letter	Attachment C 11 25 14.doc	No		Paper Only
Other-Non response questionnaire	Attachment D 11 25 14.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: 4,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,320	1,320
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.