Information Collection

2019-2020 Retail Food Stores - Completion of Sections 1 and 3

IC 217132 under ICR 201909-0910-001 · OMB 0910-0799.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0799 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B_DC Institutional_Retail_Marking Instructions.doc	Instruction
Retail Food Store Data Collection Forms.pdf	Other-Survey

IC Title:

2019-2020 Retail Food Stores - Completion of Sections 1 and 3

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
Instruction			Attachment B_DC Institutional_Retail_Marking Instructions.doc		Yes	No	Paper Only
Other-Survey			Retail Food Store Data Collection Forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	400	400
Annual IC Time Burden (Hours)	1,200	1,200
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.