Information Collection

Retail Food Stores - Form FDA 3967

IC 264415 under ICR 202401-0910-002 · OMB 0910-0744.

Documents and Forms

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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Instruction			ICR Attachment B_RFS Marking Instructions 2-22-24.pdf		Yes	Yes	Fillable Fileable
Form	FDA 3967	Retail Food Store Data Collection Form	0744_FDA 3967.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	800	800
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.