Assessment of Chemical Exposures (ACE) Investigations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Methyl Bromide Release at a Condominium Resort - U.S. Virgin Islands	Form and Instruction	New	Repair queued
Att I NCEH-ATSDR Research Determination ACE.pdf	Supplementary Document	Uploaded 2015-03-05	Available
Att H ACE Consent Forms_SAMPLE _Clean.docx	Supplementary Document	Uploaded 2015-03-05	Available
Att C MMWR ChlorExp MetalRecyclngFacility_SAMPLE.pdf	Supplementary Document	Uploaded 2015-03-05	Available
Appx 8 Decision Tree for ACE Investigations.docx	Supplementary Document	Uploaded 2015-03-05	Available
Appx 7 VetChartAbstrct Form_SAMPLE.docx	Supplementary Document	Uploaded 2015-03-05	Available
Att G Steps for Using Generic Clearance for ACE _Clean March 2 2015.docx	Supplementary Document	Uploaded 2015-03-05	Available
Att F ACE Burden Memo.docx	Supplementary Document	Uploaded 2015-03-05	Available
Att E ACE Investigation GenIC Advance Notification Email _Clean March 2 2015.docx	Supplementary Document	Uploaded 2015-03-05	Repair queued
Att D Request ACE Investsgtn Form_March 2 2015 Clean.docx	Supplementary Document	Uploaded 2015-03-05	Available
Att B 60-day FRN 5272014.pdf	Supplementary Document	Uploaded 2014-09-22	Available
Att A AuthLegisl-Combined .docx	Supplementary Document	Uploaded 2014-09-22	Available
Appx 6 MedChartAbstrct Form_SAMPLE_Clean.docx	Supplementary Document	Uploaded 2015-03-05	Available
Appx 5 HospSurvey_SAMPLE_Clean March 2015.docx	Supplementary Document	Uploaded 2015-03-05	Available
Appx 4 HHSurvey_SAMPLE_March 2_Clean.docx	Supplementary Document	Uploaded 2015-03-05	Available
Appx 3 RRR Form_SAMPLE.docx	Supplementary Document	Uploaded 2015-03-05	Available
Appx 2 GenSurvey_SAMPLE_March 2_Clean.docx	Supplementary Document	Uploaded 2015-03-05	Available
Appx 1 Past ACE Investigations.docx	Supplementary Document	Uploaded 2015-03-05	Available
ACE Supporting Statement B Clean OMB_March 2 2015.docx	Supporting Statement B	Uploaded 2015-03-05	Available
ACE Supporting Statement A_Clean March 2.docx	Supporting Statement A	Uploaded 2015-03-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215956	Methyl Bromide Release at a Condominium Resort - U.S. Virgin Islands	Form and Instruction	New

ICR Details

OMB Control No: 0923-0051	ICR Reference No: 201409-0923-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/TSDR	Agency Tracking No: 14AEH
Title: Assessment of Chemical Exposures (ACE) Investigations
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/10/2015
	Date Received in OIRA: 10/09/2014
Terms of Clearance: CDC will submit a Part B for each Gen IC submission, and provide a justification for any ICs longer than 30 minutes. If a short approval time is requested (24- or 72-hrs), CDC will also provide a justification based on a public health need.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved
Responses	3,870	0	0
Time Burden (Hours)	1,773	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Supporting effective epidemiologic investigations is an important way that ATSDR serves to protect the health of the public. In order for an ACE investigation to occur, the following criteria must be met: 1) ACE investigations will be undertaken at the request of, and in collaboration with, the state, regional, local, or tribal health department (the requesting agency) where the release occurred. 2) ACE investigations will be carried out in the event of an acute chemical release of toxic substances. 3) ACE investigations will be non research public health responses that are designed to prevent or control disease or injury and improve public health 4) ACE investigations will be restricted to domestic incidents. 5) ACE investigations will be completed within 180 days after OMB approval. ATSDR seeks approval for this Generic ICR to ensure that the agency is poised to mobilize quickly when urgent epidemiologic support is requested by our partners. Therefore, ATSDR requests 72-hour approval, or more quickly if needed.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   US Code: 42 USC 9604 Name of Law: Comprehensive Environmental Response, Compensation and Liability Act of 1980
   US Code: 42 USC 9626 Name of Law: Superfund Amendments and Reauthorization Act of 1986
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 30146	05/27/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 57108	09/24/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Methyl Bromide Release at a Condominium Resort - U.S. Virgin Islands	None	ACE Adult/Child/Pet Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,870	0	0	3,870	0	0
Annual Time Burden (Hours)	1,773	0	0	1,773	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Submission is a NEW Generic IC.

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Annual Cost to Federal Government: $41,196

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/09/2014

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