Information Collection

Foodborne Illness Valuation Survey

IC 272307 under ICR 202411-0536-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Foodborne Illness Valuation Survey	Form and Instruction
US Acute Survey Appendix B1 US Acute Survey.docx	Form and Instruction
US Acute Survey Appendix B1 US Acute Survey.docx	Form and Instruction
US Severe Survey Appendix B2 US Severe Survey.docx	Form and Instruction
US Severe Survey Appendix B2 US Severe Survey.docx	Form and Instruction

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
Form and Instruction	NA	US Acute Survey	Appendix B1 US Acute Survey.docx		Yes	Yes	Fillable Fileable
Form and Instruction	NA	US Severe Survey	Appendix B2 US Severe Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	2,000	2,000
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.