Information Collection

In-Home Food Safety Behaviors and Consumer Education: Annual Observational Study

IC 226809 under ICR 202203-0583-001 · OMB 0583-0169.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E_screening questionnaire.docx	Other-screening questionnaire
Appendix E_screening questionnaire.docx	Other-screening questionnaire
Appendix H_Reminder Call Script_final 5-26-20.docx Reminder Call Script	IC Document
Appendix H_Reminder Call Script_final 5-26-20.docx Reminder Call Script	IC Document
Appendix F_Recruit Call Script__COVID.docx Recruit Call Script	IC Document
Appendix F_Recruit Call Script__COVID.docx Recruit Call Script	IC Document
Appendix G_Confirmation Email__COVID.docx Confirmation Email	IC Document
Appendix G_Confirmation Email__COVID.docx Confirmation Email	IC Document
Appendix K_IRB_Approval_COVID.docx IRB Approval	IC Document
Appendix K_IRB_Approval_COVID.docx IRB Approval	IC Document
Appendix N_day of screening tool_COVID.docx Day of Screening	IC Document
Appendix N_day of screening tool_COVID.docx Day of Screening	IC Document
Appendix A_study design_Yr 5.docx Study Design	IC Document
Appendix A_study design_Yr 5.docx Study Design	IC Document
Appendix B_recruiting ads.docx Recruiting Ads	IC Document
Appendix B_recruiting ads.docx Recruiting Ads	IC Document
Appendix C_Recruiting Email.docx Recruiting Email	IC Document
Appendix C_Recruiting Email.docx Recruiting Email	IC Document
Appendix D_recruiting sign.docx Recruiting Sign	IC Document
Appendix D_recruiting sign.docx Recruiting Sign	IC Document
Appendix J_consent_form.docx Consent Form	IC Document
Appendix J_consent_form.docx Consent Form	IC Document
Appendix L_instructions_and_recipes.docx Instructions and Recipes	IC Document
Appendix L_instructions_and_recipes.docx Instructions and Recipes	IC Document
Appendix M_additional_COVID procedures.docx Additional COVID procedures	IC Document
Appendix M_additional_COVID procedures.docx Additional COVID procedures	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

In-Home Food Safety Behaviors and Consumer Education: Annual Observational Study

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
Other-screening questionnaire					Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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)	872	872
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Reminder Call Script		05/27/2020
Recruit Call Script		08/06/2020
Confirmation Email		08/06/2020
IRB Approval		08/06/2020
Day of Screening		08/06/2020
Study Design		03/04/2022
Recruiting Ads		03/04/2022
Recruiting Email		03/04/2022
Recruiting Sign		03/04/2022
Consent Form		03/04/2022
Instructions and Recipes		03/04/2022
Additional COVID procedures		03/04/2022

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

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