Information Collection Request

Survey on the Occurrence of Foodborne Illness Risk Factors in Selected Restaurant and Retail Foodservice Facility Types

ICR 202401-0910-002 · OMB 0910-0744 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form FDA 3967 Retail Food Store Data Collection Form Form New Repair queued
Form FDA 3966 Restaurant Data Collection Record Form Modified Available
Form FDA 3967 Retail Food Store Data Collection Form Form Modified Repair queued
Form FDA 3966 Restaurant Data Collection Record Form Modified Available
0744 Supporting Statement Part A 2024 (1).docx Supporting Statement A Uploaded 2024-08-23 Repair queued
0744_Supporting Statement Part B 2024.docx Supporting Statement B Uploaded 2024-08-23 Repair queued
ICR Attachment E_CDC-FDA Data Collection Collaboration.pdf Supplementary Document Uploaded 2024-08-30 Repair queued
ICR Attachment D_Intro Letter combined 0744.pdf Supplementary Document Uploaded 2024-08-30 Repair queued
ICR Attachment A_RiskFactorStudy_Protocol_ 2-22-24.pdf Supplementary Document Uploaded 2024-08-30 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
264415 Retail Food Stores - Form FDA 3967 Form NewRetail Food Store Data Collection Form
264415 Retail Food Stores - Form FDA 3967 Instruction New
207991 Refusal Form ModifiedRestaurant Data Collection Record
207991 Refusal Form ModifiedRetail Food Store Data Collection Form
207991 Refusal Other-Instructions Modified
207990 Fast-Food and Full-Service Restaurants--Form FDA 3966 Form ModifiedRestaurant Data Collection Record
207990 Fast-Food and Full-Service Restaurants--Form FDA 3966 Other-Instructions Modified
204849 2021-2022 - Full Service Restaurants - Completion of Sections 1 and 3 Other-Instructions Removed
204848 2021-2022 - Fast Food Restaurants - Completion of Sections 1 and 3 Other-Instructions Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2027 36 Months From Approved 09/30/2024
824 0 1,616
1,602 0 1,637
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
2021-2022 - Fast Food Restaurants - Completion of Sections 1 and 3
2021-2022 - Full Service Restaurants - Completion of Sections 1 and 3
Fast-Food and Full-Service Restaurants--Form FDA 3966 FDA 3966
Refusal FDA 3967, FDA 3966 ,  
Retail Food Stores - Form FDA 3967 FDA 3967

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 824 1,616 0 0 -792 0
Annual Time Burden (Hours) 1,602 1,637 0 0 -35 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No