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 Name	Document Type
Form FDA 5017 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

IC Title:

Agency IC Tracking Number:

CFSAN

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 1

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 5017	Standardized Retail Food Safety Inspection Officer Waiver of Annual Maintenance Requirement Form	FDA-5017_Stat_Sec_Ext_08-31-2023.docx	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 5018	Standardized Retail Food Safety Inspection Officer Annual Maintenance Form	FDA-5018_Dyn_extended_secured_08-31-2023.docx	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 5019	Standardized Food Safety Inspection Officer Nomination Form	FDA-5019_Stat_Sec_Ext_08-31-2023.docx	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 3958	Voluntary National Retail Food Regulatory Program Standards FDA National Registry Report	FDA-3958Temp_Stat_Sec_Ext_06-07-2023.docx	Yes	Yes	Fillable Fileable
Other-Program Standards			ProgramStandards2022-VNRFRPS-Compiledupdate.pdf	Yes	Yes	Fillable Fileable
Other-Summary of Changes			ProgramStandards2022_SummaryofChanges.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: General Personnel Records

FR Citation: 80 FR 74815

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

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