Healthcare Facilities - Completion of Sections 1 and 3

Survey on the Occurrence of Foodborne Illness Risks Factors in Selected Institutional Foodservice and Retail Food Stores Facility Types (2015-2025)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0799 can be found here:

Documents and Forms

Document Name Document Type
QUESTIONNAIRE FORM FOR RETAIL FOOD STORES 5-28-15.doc Other-Survey
MARKING INSTRUCTIONS FOR RETAIL FOOD STORES 5-28-15.doc Instruction

Information Collection (IC) Details

IC Title:	Healthcare Facilities - Completion of Sections 1 and 3	Agency IC Tracking Number:	ORA

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			QUESTIONNAIRE FORM FOR RETAIL FOOD STORES 5-28-15.doc		Yes	Yes	Fillable Fileable
Instruction			MARKING INSTRUCTIONS FOR RETAIL FOOD STORES 5-28-15.doc		Yes	No	Paper Only

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: 25 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.