Restaurant Observation

Assessment of Ill Worker Policies Study

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Restaurant Observation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	106	106
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.