Cognitive Interview screener

Food Safety Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0345 can be found here:

Documents and Forms

Document Name Document Type
Appendix A Questionnaire 11 25 14.doc Other-Questionnaire
Attachement B 11 25 14.doc Other-Letter to respondent
Attachment C 11 25 14.doc Other-Non response letter
Attachment D 11 25 14.doc Other-Non response questionnaire

Information Collection (IC) Details

IC Title:	Cognitive Interview screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire	Appendix A Questionnaire 11 25 14.doc	Yes	Yes	Fillable Fileable
Other-Letter to respondent	Attachement B 11 25 14.doc	No		Paper Only
Other-Non response letter	Attachment C 11 25 14.doc	No		Paper Only
Other-Non response questionnaire	Attachment D 11 25 14.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	6	6
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.