FY2016Q2 - ACE Investigations Burden Memo

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

1. ACE Investigation GenIC No.:	0923-0051
2. Title of Investigation:	Flint Rash Investigation
3. Chemical Incident	Rashes potentially associated with Flint water supply
Investigated:
4. Date of Investigation:	Beginning: 2/26/2016
	End: 5/23/2016
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): _______390__________

Total No. Sampled/Eligible to Respond (B): _______429__________

Response Rate (A/B): _______90.9%________

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):

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)
Questionnaire	general public	390	1	23	8970
Dermatology Medical Charts	n/a	122	1	6	732