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Flint Rash Investigation
Assessment of Chemical Exposures (ACE) Investigations - FY2016 Q2 Burden Report
OMB: 0923-0051
IC ID: 221128
OMB.report
HHS/TSDR
OMB 0923-0051
ICR 201607-0923-002
IC 221128
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0051 can be found here:
2024-10-02 - Revision of a currently approved collection
2021-05-26 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
Flint Rash Investigation
Form and Instruction
Follow-Up Flint Rash Dermatology Report Form
Att B Flint Rash Dermatology Follow-up Report Form.docx
Form and Instruction
Att A MDHHS Derm Follow up assistance request 0419-2016.pdf
Letter of Invitation
IC Document
SSB ACE Invstg Flint Rash Drmtlgy Fllw-up.docx
Supporting Statement B
IC Document
Att C Flint Rash Dermatology Follow-up RDF Signed.pdf
Research Determination
IC Document
Request ACE Investsgtn Form_Flint Rash Follow-up.pdf
0923-0051 GenIC Request
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Flint Rash Investigation
Agency IC Tracking Number:
16AEB
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
NA
Follow-Up Flint Rash Dermatology Report Form
Att B Flint Rash Dermatology Follow-up Report Form.docx
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
09-19-0001 Record of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances
FR Citation:
76 FR 4432
Number of Respondents:
150
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
150
0
0
0
0
150
Annual IC Time Burden (Hours)
25
0
0
0
0
25
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter of Invitation
Att A MDHHS Derm Follow up assistance request 0419-2016.pdf
04/19/2016
Supporting Statement B
SSB ACE Invstg Flint Rash Drmtlgy Fllw-up.docx
04/19/2016
Research Determination
Att C Flint Rash Dermatology Follow-up RDF Signed.pdf
04/19/2016
0923-0051 GenIC Request
Request ACE Investsgtn Form_Flint Rash Follow-up.pdf
04/19/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.