Information Collection

Focus Group Research to Inform Consumer Food Safety Education and Outreach

IC 244798 under ICR 202012-0583-003 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B_Food Recall_ModeratorGuide_11_30_20.pdf	Other-food recall moderator guide
Appendix D_MCI_Moderator Guide__11_30_20.pdf	Other-MCI moderator guide
Appendix A_Food Recall _Screener_11_30_20.docx food recall screener	IC Document
Appendix C_MCI_Screener_11_30_20.docx MCI screener	IC Document
Appendix E_Consent Form_Recall_12_17_20.docx consent form recall	IC Document
Appendix F_Consent Form_MCI_12_17_20.docx consent form MCI	IC Document
Appendix G_COVID consent addendum_12_17_20.docx COVID consent	IC Document
Appendix H_COVID Day of screening tool_12_17_20.docx COVID day of screening	IC Document
Appendix I_procedures COVID_12_17_20.docx procedures COVID	IC Document

IC Title:

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
Other-food recall moderator guide			Appendix B_Food Recall_ModeratorGuide_11_30_20.pdf		No		Paper Only
Other-MCI moderator guide			Appendix D_MCI_Moderator Guide__11_30_20.pdf		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 160

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
food recall screener	Appendix A_Food Recall _Screener_11_30_20.docx	12/08/2020
MCI screener	Appendix C_MCI_Screener_11_30_20.docx	12/08/2020
consent form recall	Appendix E_Consent Form_Recall_12_17_20.docx	12/22/2020
consent form MCI	Appendix F_Consent Form_MCI_12_17_20.docx	12/22/2020
COVID consent	Appendix G_COVID consent addendum_12_17_20.docx	12/22/2020
COVID day of screening	Appendix H_COVID Day of screening tool_12_17_20.docx	12/22/2020
procedures COVID	Appendix I_procedures COVID_12_17_20.docx	12/22/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.