Information Collection

Pretest Screener (phone and mail); Pretest (phone and mail); Survey Screener (phone and mail); Phone Survey; Mail Survey

IC 190818 under ICR 202407-0910-012 · OMB 0910-0345.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0345 survey script.xlsx	Other-survey script
FSANS_FoodSafety Survey_pretest-090425.docx	Other-Pretest - Food Safety Survey
FSANS_Nutrition Survey Pretest-090425.docx	Other-Nutrition Survey Pretest

IC Title:

Agency IC Tracking Number:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey script	0345 survey script.xlsx	Yes	Yes	Fillable Fileable
Other-Pretest - Food Safety Survey	FSANS_FoodSafety Survey_pretest-090425.docx	Yes	Yes	Fillable Printable
Other-Nutrition Survey Pretest	FSANS_Nutrition Survey Pretest-090425.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 66,265

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	66,265	6,100	60,165
Annual IC Time Burden (Hours)	2,845	1,683	1,162
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.