Information Collection

Laboratory Assessment Requests

IC 242068 under ICR 202603-0583-004 · OMB 0583-0183.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 8000-17 Evidence Receipt and Chain of Custody Laboratory Assessment Requests	Form
8000-17 Evidence Receipt and Chain of Custody FSIS 8000-17 EVIDENCE RECEIPT AND CHAIN OF CUSTODY.pdf	Form

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	8000-17				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	23	23
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.

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