Customer Satisfaction Survey for FDA CFSAN Technical Assistance Network Web Form for Submitting Food Safety Modernization Act Queries

OMB No. 0910-0360 Expiration Date 09/30/2017

Public reporting burden for this collection of information is estimated to be 2 minutes, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information to Food and Drug Administration (FDA) Office Operations, 3WFN, 11601 Landsdown Street, North Bethesda, MD 20852. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The control number for this project is 0910-0360.

Your participation/nonparticipation is completely voluntary, and your responses will not have an effect on your eligibility for receipt of any FDA services. In instances where respondent identity is needed (e.g., for follow-up of non-responders), this information collection fully complies with all aspects of the Privacy Act and data will be kept private to the fullest extent allowed by law.

U. S. Department of Health & Human Services

Food and Drug Administration

Center for Food Safety and Applied Nutrition

Food and Cosmetics Information Center Inquiry Form Customer Satisfaction Survey

Your participation/nonparticipation in the following survey is completely voluntary and your responses will not have an effect on your eligibility for receipt of any FDA services. This information collection fully complies with all aspects of the Privacy Act and data will be kept private to the fullest extent allowed by law.

Please complete the following information regarding the use of the Food and Cosmetics Information Center (FCIC) Inquiry Form. Thank you for taking the time to complete this survey.

1. How did you learn about this web form?

OVERALL FORM CLARITY	1	2	3	4	5
Were the web form instructions clear?	○ Not Clear	○	○	○	○ Very Clear

3. What improvements can be made to this web form?

Thank you for your feedback!