Retail Food Stores - Form FDA 3967

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 Instruction
FDA 3967 Retail Food Store Data Collection Form 0744_FDA 3967.pdf Form

Information Collection (IC) Details

IC Title:	Retail Food Stores - Form FDA 3967	Agency IC Tracking Number:

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
Instruction			ICR Attachment B_RFS Marking Instructions 2-22-24.pdf		Yes	Yes	Fillable Fileable
Form	FDA 3967	Retail Food Store Data Collection Form	0744_FDA 3967.pdf		Yes	Yes	Fillable Fileable Signable

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: 100 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	800	800
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.