Retail Food Stores - Completion of Sections 1 and 3

Survey on the Occurrence of Foodborne Illness Risks Factors in Selected Institutional Foodservice and Retail Food Stores Facility Types

Documents and Forms

Document Name Document Type
Attachment B_DC Institutional_Retail_Marking Instructions.pdf Instruction
Attachment B_DC Institutional_Retail_Marking Instructions.pdf Instruction
Retail Food Store Data Collection Forms.pdf Other-Survey
Retail Food Store Data Collection Forms.pdf Other-Survey

Information Collection (IC) Details

IC Title:	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:

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.pdf		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 %

	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

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.