Information Collection

Restaurant intervention log - intervention restaurants

IC 245315 under ICR 202204-0920-004 · OMB 0920-1227.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Restaurant intervention log - intervention restaurants	Form
Restaurant intervention log P_Att 5 Intervention Log 201211.docx	Form
Restaurant intervention log P_Att 5 Intervention Log 201211.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	none	Restaurant intervention log	P_Att 5 Intervention Log 201211.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	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.