Information Collection

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

IC 226809 under ICR 202203-0583-001 · OMB 0583-0169.

Documents and Forms

Document Name Document Type
Appendix E_screening questionnaire.docx Other-screening questionnaire
Appendix E_screening questionnaire.docx Other-screening questionnaire
Appendix H_Reminder Call Script_final 5-26-20.docx Reminder Call Script IC Document
Appendix H_Reminder Call Script_final 5-26-20.docx Reminder Call Script IC Document
Appendix F_Recruit Call Script__COVID.docx Recruit Call Script IC Document
Appendix F_Recruit Call Script__COVID.docx Recruit Call Script IC Document
Appendix G_Confirmation Email__COVID.docx Confirmation Email IC Document
Appendix G_Confirmation Email__COVID.docx Confirmation Email IC Document
Appendix K_IRB_Approval_COVID.docx IRB Approval IC Document
Appendix K_IRB_Approval_COVID.docx IRB Approval IC Document
Appendix N_day of screening tool_COVID.docx Day of Screening IC Document
Appendix N_day of screening tool_COVID.docx Day of Screening IC Document
Appendix A_study design_Yr 5.docx Study Design IC Document
Appendix A_study design_Yr 5.docx Study Design IC Document
Appendix B_recruiting ads.docx Recruiting Ads IC Document
Appendix B_recruiting ads.docx Recruiting Ads IC Document
Appendix C_Recruiting Email.docx Recruiting Email IC Document
Appendix C_Recruiting Email.docx Recruiting Email IC Document
Appendix D_recruiting sign.docx Recruiting Sign IC Document
Appendix D_recruiting sign.docx Recruiting Sign IC Document
Appendix J_consent_form.docx Consent Form IC Document
Appendix J_consent_form.docx Consent Form IC Document
Appendix L_instructions_and_recipes.docx Instructions and Recipes IC Document
Appendix L_instructions_and_recipes.docx Instructions and Recipes IC Document
Appendix M_additional_COVID procedures.docx Additional COVID procedures IC Document
Appendix M_additional_COVID procedures.docx Additional COVID procedures 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 questionnaire			Appendix E_screening questionnaire.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	872	872
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Reminder Call Script	Appendix H_Reminder Call Script_final 5-26-20.docx	05/27/2020
Recruit Call Script	Appendix F_Recruit Call Script__COVID.docx	08/06/2020
Confirmation Email	Appendix G_Confirmation Email__COVID.docx	08/06/2020
IRB Approval	Appendix K_IRB_Approval_COVID.docx	08/06/2020
Day of Screening	Appendix N_day of screening tool_COVID.docx	08/06/2020
Study Design	Appendix A_study design_Yr 5.docx	03/04/2022
Recruiting Ads	Appendix B_recruiting ads.docx	03/04/2022
Recruiting Email	Appendix C_Recruiting Email.docx	03/04/2022
Recruiting Sign	Appendix D_recruiting sign.docx	03/04/2022
Consent Form	Appendix J_consent_form.docx	03/04/2022
Instructions and Recipes	Appendix L_instructions_and_recipes.docx	03/04/2022
Additional COVID procedures	Appendix M_additional_COVID procedures.docx	03/04/2022

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