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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.