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Federal forms, ICRs, and supporting documents

Information Collection

Voluntary National Retail Standards: Worksheets and assessments

IC 183428 under ICR 202306-0910-002 · OMB 0910-0621.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form FDA 5017
Voluntary National Retail Standards: Worksheets and assessments		 Form and Instruction
Form FDA 5017
Standardized Retail Food Safety Inspection Officer Waiver of Annual Maintenance Requirement Form Voluntary National Retail Standards: Worksheets and assessments		 Form and Instruction
Form FDA 5018
Standardized Retail Food Safety Inspection Officer Annual Maintenance Form Voluntary National Retail Standards: Worksheets and assessments		 Form and Instruction
Form FDA 5019
Standardized Food Safety Inspection Officer Nomination Form Voluntary National Retail Standards: Worksheets and assessments		 Form and Instruction
Form FDA 3958
Voluntary National Retail Food Regulatory Program Standards FDA National Registry Report Voluntary National Retail Standards: Worksheets and assessments		 Form and Instruction
ProgramStandards2022-VNRFRPS-Compiledupdate.pdf Other-Program Standards
ProgramStandards2022-VNRFRPS-Compiledupdate.pdf Other-Program Standards
ProgramStandards2022_SummaryofChanges.pdf Other-Summary of Changes
ProgramStandards2022_SummaryofChanges.pdf Other-Summary of Changes
FDA 5017 Standardized Retail Food Safety Inspection Officer Waive
FDA-5017_Stat_Sec_Ext_08-31-2023.docx 		Form and Instruction
FDA 5017 Standardized Retail Food Safety Inspection Officer Waive
FDA-5017_Stat_Sec_Ext_08-31-2023.docx 		Form and Instruction
FDA 5018 Standardized Retail Food Safety Inspection Officer Annua
FDA-5018_Dyn_extended_secured_08-31-2023.docx 		Form and Instruction
FDA 5018 Standardized Retail Food Safety Inspection Officer Annua
FDA-5018_Dyn_extended_secured_08-31-2023.docx 		Form and Instruction
FDA 5019 Standardized Food Safety Inspection Officer Nomination F
FDA-5019_Stat_Sec_Ext_08-31-2023.docx 		Form and Instruction
FDA 5019 Standardized Food Safety Inspection Officer Nomination F
FDA-5019_Stat_Sec_Ext_08-31-2023.docx 		Form and Instruction
FDA 3958 Voluntary National Retail Food Regulatory Program Standa
FDA-3958Temp_Stat_Sec_Ext_06-07-2023.docx 		Form and Instruction
FDA 3958 Voluntary National Retail Food Regulatory Program Standa
FDA-3958Temp_Stat_Sec_Ext_06-07-2023.docx 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 and Instruction FDA 5017 Yes Yes Fillable Fileable
Form and Instruction FDA 5018 Yes Yes Fillable Fileable
Form and Instruction FDA 5019 Yes Yes Fillable Fileable
Form and Instruction FDA 3958 Yes Yes Fillable Fileable
Other-Program Standards Yes Yes Fillable Fileable
Other-Summary of Changes Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,154 0 0 3,654 0 500
Annual IC Time Burden (Hours) 283,122 0 0 235,977 0 47,145
Annual IC Cost Burden (Dollars) 0 0 0 0 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.
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