Information Collection

2021-2022 - Refusals – All Facility Types

IC 207991 under ICR 201806-0910-013 · OMB 0910-0744.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0744 can be found here:

Documents and Forms

Document Name Document Type
Attachment C_Restaurant Data Collection Form for FoodSHIELD.pdf Other-Survey
Attachment B_Marking Instruction for the RFS Data Collection.pdf Other-Instructions

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2021-2022 - Refusals â All Facility Types	Agency IC Tracking Number:	ORA

Is this a Common Form? No		IC Status: Modified

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
Other-Survey			Attachment C_Restaurant Data Collection Form for FoodSHIELD.pdf		Yes	Yes	Fillable Fileable
Other-Instructions			Attachment B_Marking Instruction for the RFS Data Collection.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.