ACE Burden Memo - FY2015 Q3

Attachment F –Assessment of Chemical Exposures (ACE) Investigations Burden Memo (0923-0051)

1. ACE Investigation GenIC No.:	0923-0051
2. Title of Investigation:	Methyl Bromide Release at a Condominium Resort
3. Chemical Incident	Indoor methyl bromide release by pest control company at a
Investigated:	condominium resort in the U.S. Virgin Islands
4. Date of Investigation:	Beginning: April 6, 2015
	End: May 4, 2015
5. Name, CIO, and Contact Information of Lead Investigator:
Mary Anne Duncan, ATSDR	maduncan@cdc.gov, 770-488-3668
Complete this section for each instrument used during the investigation. Data Collection Method (check all that apply): Questionnaire: Face-to-face Interview Telephone Interview □ Self-administered Paper and Pencil □ Self-administered Internet Focus Group Medical Chart Review Hospital Survey Laboratory Sample Other (please specify):

Response Rate (if applicable):

Total No. Responded (A): _____16_____________

Total No. Sampled/Eligible to Respond (B): _____20_____________

Response Rate (A/B): _____80%____________

Burden Table (insert rows for additional respondent types if needed)

Data Collection Instrument Name	Type of Respondent (e.g., general public, health care providers, responders, employees of the company)	Number of Respondents (A)	Number of Responses per Respondent (B)	Burden per Response (minutes) (C)	Total Burden (in minutes; A x B x C)
ACE General Adult Survey	Responders, employees of condominium complex, general public	16	1	25	400