Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appx C - Health screening questionnaire - Field app (M) New 30 15 0 Other-App
Appx D - Heat Stress app -- shift questionnaire for field (M) New 120 2 0 Other-App
Appx E - Heat stress app - post-shift questionnaire (field) (M) New 60 10 0 Other-App (WORD)
Appx F_Physcal Examination (M/FF/CW) New 15 3 0 Other-WORD
Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW) New 15 8 0 Other-App
Appx H_PANAS sleepiness fatigue (M/FF/CW) New 75 3 0 Other-WORD
Appx I_ Pre-Test Questionnaire (M/FF/CW) New 30 3 0 Other-App (WORD)
Appx L_Consent Form Field Study (M) New 30 15 0 Form and Instruction 0920- Health-related changes in cognitive performance - Field component
Appx M_ Consent Form Environment Chamber (M/FF/CW) New 15 8 0 Form and Instruction 0920 Health-related changes in cognitive performance Environmental chamber component
Borg and Thermal Scale (M/FF/CW) New 25 2 0 Form 0920 Bor and Thermail Sensaton Scale
Cognitive test: N-back -- no form (M/FF/CW) New 75 2 0 Instruction
Fingerstick blood sample for point of care testing New 8 1 0 Instruction
Fitting of Chest Strap (M) New 60 1 0 Instruction
Fitting of Chest Strap (M/FF/CW) New 45 1 0 Instruction
Ingestion of Temperature Pill (M) New 60 1 0 Instruction
Ingestion of Temperature Pill (M/FF/CW) New 45 1 0 Instruction
PVT Cognitive Test - Field (M) New 150 13 0 Instruction
PVT Cognitive Test - Field (M/FF/CW) New 75 13 0 Instruction
Release of Information (HIPPA) (M/FF/CW) New 3 1 0 Form 0920 Release of Information (HIPAA Privacy Authorization Form)
Total burden requested under this ICR: 936 103 0  
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