Refusal

Survey on the Occurrence of Foodborne Illness Risk Factors in Selected Restaurant and Retail Foodservice Facility Types

Documents and Forms

Document Name Document Type
ICR Attachment B_RFS Marking Instructions 2-22-24.pdf Other-Instructions
FDA 3967 Retail Food Store Data Collection Form Attachment C - Restaurant Data Collection Form.pdf Form
FDA 3966 Restaurant Data Collection Record 0744_FDA 3966.pdf Form

Information Collection (IC) Details

IC Title:	Refusal	Agency IC Tracking Number:	ORA

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Instructions			ICR Attachment B_RFS Marking Instructions 2-22-24.pdf	Yes	No	Printable Only
Form	FDA 3967	Retail Food Store Data Collection Form	Attachment C - Restaurant Data Collection Form.pdf	Yes	Yes	Fillable Fileable Signable
Form	FDA 3966	Restaurant Data Collection Record	0744_FDA 3966.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24	8	16
Annual IC Time Burden (Hours)	2	1	1
Annual IC Cost Burden (Dollars)	0	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.