Information Collection

Restaurant Observation

IC 228962 under ICR 202101-0920-005 · OMB 0920-1227.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1227 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Restaurant Observation	Form and Instruction
Restaurant Observation P_Att 4 Restaurant Observation Form 201211.docx	Form and Instruction
Restaurant Observation P_Att 4 Restaurant Observation Form 201211.docx	Form and Instruction

IC Title:

Restaurant Observation

Agency IC Tracking Number:

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
Form and Instruction	none	Restaurant Observation	P_Att 4 Restaurant Observation Form 201211.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 106

Number of Respondents for Small Entity: 27

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	212	158	54
Annual IC Time Burden (Hours)	106	79	27
Annual IC Cost Burden (Dollars)	0	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.