Information Collection

Refusal

IC 207991 under ICR 202401-0910-002 · OMB 0910-0744.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 3967 Retail Food Store Data Collection Form Refusal	Form
Form FDA 3966 Restaurant Data Collection Record Refusal	Form
ICR Attachment B_RFS Marking Instructions 2-22-24.pdf	Other-Instructions
ICR Attachment B_RFS Marking Instructions 2-22-24.pdf	Other-Instructions
FDA 3967 Retail Food Store Data Collection Form Attachment C - Restaurant Data Collection Form.pdf	Form
FDA 3967 Retail Food Store Data Collection Form Attachment C - Restaurant Data Collection Form.pdf	Form
FDA 3966 Restaurant Data Collection Record 0744_FDA 3966.pdf	Form
FDA 3966 Restaurant Data Collection Record 0744_FDA 3966.pdf	Form

IC Title:

Refusal

Agency IC Tracking Number:

ORA

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Instructions		Yes	No	Printable Only
Form	FDA 3967	Yes	Yes	Fillable Fileable Signable
Form	FDA 3966	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24	8	16
Annual IC Time Burden (Hours)	2	1	1
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.

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