In-Home Food Safety Behaviors and Consumer Education: Annual Observational Study

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0583-0169 can be found here:

Documents and Forms

Document Name Document Type
Appx E_Screening Questionnaires_6_28_17.docx Other-screening questionnaires
Appx E_Screening Questionnaires__Span 11_7_17.docx Other-screening questionnaires Spani
Appx A_study design.docx Study Design IC Document
Appx B_recruiting ads.docx Recruiting Ads IC Document
Appx C_Recruiting Email.docx Recruiting Email IC Document
Appx D_Recruiting Sign.docx Recruiting Sign IC Document
Appx F_Recruit Call Script.docx Recruiting Call Script IC Document
Appx G_Confirmation Email.docx Confirmation Email IC Document
Appx H_Reminder Call Script.docx Reminder Call Script IC Document
Appx J_Consent Form_5_10_17.docx Consent Form IC Document
Appx L_Recipes and Instructions.docx Recipes and Instructions IC Document
Appx B_recruiting ads_Span 11_7_17.docx Recruiting Ads Spanish IC Document
Appx C_Recruiting Email_Span 11_7_17.docx Recruiting Email Spanish IC Document
Appx D_Recruiting Sign_Span 11_7_17.docx Recruiting Sign Spanish IC Document
Appx F_Recruit Call Script_Span 11_7_17.docx Recruiting Call Script Spanish IC Document
Appx G_Confirmation Email_Span 11_7_17.docx Confirmation Email Spanish IC Document
Appx H_Reminder Call Script_Span 11_7_17.docx Reminder Call Script Spanish IC Document
Appx J_Consent Form_Span 11_7_17.docx Consent Form Spanish IC Document
Appx L_Recipes and Instructions_Span 11_7_17.docx Recipes and Instructions Spanish IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	In-Home Food Safety Behaviors and Consumer Education: Annual Observational Study	Agency IC Tracking Number:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-screening questionnaires			Appx E_Screening Questionnaires_6_28_17.docx		No		Paper Only
Other-screening questionnaires Spanish			Appx E_Screening Questionnaires__Span 11_7_17.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,999	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,999	1,999
Annual IC Time Burden (Hours)	2,942	2,942
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Study Design	Appx A_study design.docx	05/17/2017
Recruiting Ads	Appx B_recruiting ads.docx	05/17/2017
Recruiting Email	Appx C_Recruiting Email.docx	05/17/2017
Recruiting Sign	Appx D_Recruiting Sign.docx	05/17/2017
Recruiting Call Script	Appx F_Recruit Call Script.docx	05/17/2017
Confirmation Email	Appx G_Confirmation Email.docx	05/17/2017
Reminder Call Script	Appx H_Reminder Call Script.docx	05/17/2017
Consent Form	Appx J_Consent Form_5_10_17.docx	05/17/2017
Recipes and Instructions	Appx L_Recipes and Instructions.docx	05/17/2017
Recruiting Ads Spanish	Appx B_recruiting ads_Span 11_7_17.docx	11/14/2017
Recruiting Email Spanish	Appx C_Recruiting Email_Span 11_7_17.docx	11/14/2017
Recruiting Sign Spanish	Appx D_Recruiting Sign_Span 11_7_17.docx	11/14/2017
Recruiting Call Script Spanish	Appx F_Recruit Call Script_Span 11_7_17.docx	11/14/2017
Confirmation Email Spanish	Appx G_Confirmation Email_Span 11_7_17.docx	11/14/2017
Reminder Call Script Spanish	Appx H_Reminder Call Script_Span 11_7_17.docx	11/14/2017
Consent Form Spanish	Appx J_Consent Form_Span 11_7_17.docx	11/14/2017
Recipes and Instructions Spanish	Appx L_Recipes and Instructions_Span 11_7_17.docx	11/14/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.