Information Collection

Food Worker Consent and Survey - Control Visit 3

IC 228969 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Food Worker Consent and Survey - Control Visit 3 Form
Food Worker Consent and Survey Att 7 Food Wrkr Infrmd Cnsnt and Srvy Frm.docx Form
Food Worker Consent and Survey Att 7 Food Wrkr Infrmd Cnsnt and Srvy Frm.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Food Worker Consent and Survey - Control Visit 3	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Form	none	Food Worker Consent and Survey	Att 7 Food Wrkr Infrmd Cnsnt and Srvy Frm.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 270	Number of Respondents for Small Entity: 134

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

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-270	270
Annual IC Time Burden (Hours)	-23	23
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.