Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appx C_Initial Participant Questionnaire: Field (Health screening) Modified 30 15 0 Form and Instruction 0920-1331 Initial Participant Questionnaire: Field
Appx D - Questionnaire on Heat Stress (App) Miners-- Shift for field Modified 120 2 0 Other-App (WORD)
Appx E -Pre-Shift Questionnaire on Heat Stress (App) Miners Modified 60 10 0 Other-App (WORD)
Appx F_Physcal Examination (M/FF/CW) Modified 15 3 0 Form 0920-1331 Physical Examination
Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW) Modified 15 8 0 Form 0920-1331 Initial Participant Questionnaire: Chamber
Appx H_PANAS sleepiness fatigue (M/FF/CW) Unchanged 75 3 0 Other-WORD
Appx I_ Pre-Test Questionnaire (M/FF/CW) Unchanged 30 3 0 Other-App (WORD)
Appx K_Field Recruitment Script (PVT Cognitive Test) _Miner Modified 150 13 0 Instruction
Appx L Consent (Field component) _Miners Modified 30 15 0 Form and Instruction 0920-1331 Consent to be in a Research Study Health-related changes in cognitive performance Field component.
Appx M_ Consent Form Environment Chamber (M/FF/CW) Modified 15 8 0 Form and Instruction 0920-1331 Consent to be in a Research Study Health-related changes in cognitive performance
Appx N_ Release of Information (HIPPA) (M/FF/CW) Modified 3 1 0 Form 0920-1331 Release of Information (HIPAA Privacy Authorization Form)
Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW) Modified 25 2 0 Form 0920-1331 Exertion and Thermal Sensation Scale
Cognitive test: N-back -- no form (M/FF/CW) Unchanged 75 2 0 Instruction
Consent - Research Study (PVT Cognitive Test) - Field (M/FF/CW) Modified 75 13 0 Instruction
Consent Form - (Ingestion of Temperature Pill (M)) Modified 60 1 0 Instruction
Fingerstick blood sample for point of care testing Unchanged 8 1 0 Instruction
Fitting of Chest Strap (M) Unchanged 60 1 0 Instruction
Fitting of Chest Strap (M/FF/CW) Unchanged 45 1 0 Instruction
Ingestion of Temperature Pill (M/FF/CW) Modified 45 1 0 Instruction
Total burden requested under this ICR: 936 103 0  
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