Flint Rash Investigation

Assessment of Chemical Exposures (ACE) Investigations - FY2016 Q2 Burden Report

OMB: 0923-0051

IC ID: 220237

Information Collection (IC) Details

View Information Collection (IC)

Flint Rash Investigation 16RV
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Self-reported Rash Symptoms and Exposure - MDHHS Questionnaire AttB Flint Questionnaire 20160224 MDHHS clean.docx No   Paper Only
Form none Flint Medical Chart Abstraction AttC Flint Medical Chart Abstraction Form 20160224.docx No   Paper Only

Health Consumer Health and Safety

Record of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances  76 FR 4432

200 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 200 0 0 0 0 200
Annual IC Time Burden (Hours) 58 0 0 0 0 58
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval Request ACE Investsgtn Form_Flint Rash Investigation 20160224 MDHHS clean.pdf 02/25/2016
Invitation from Michigan AttA Flint Rash Investigation State Request 20160223.pdf 02/25/2016
Supporting Statement B ACE Supporting Statement B_Flint Rash Investigation 20160224.docx 02/25/2016
Research Determination AttD Flint Rash Investigation Research Determination 20160224.pdf 02/25/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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