Resaturant intervention log - control restaurants

Assessment of Ill Worker Policies Study

Documents and Forms

Document Name Document Type
Resaturant intervention log - control restaurants Form and Instruction
Intervention log - control restaurants P_Att 5 Intervention Log 201211.docx Form and Instruction
Intervention log - control restaurants P_Att 5 Intervention Log 201211.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Resaturant intervention log - control restaurants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form and Instruction	none	Intervention log - control restaurants	P_Att 5 Intervention Log 201211.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	27	27
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.