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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators
Agency IC Tracking Number:
0920-1441-25BX
IC Status:
New
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
0920-1441
Informed Consent
Attachment G_Informed Consent Form.docx
N/A
No
Fillable Fileable
Form and Instruction
0920-1441
Construction_Demolition Robot Experience Questionnaire
Attachment B_ConstructionDemolition Robot Experience Questionnaire.docx
N/A
No
Fillable Fileable
Form and Instruction
0920-1441
Virtual Reality Sickness Questionnaire
Attachment C_Virtual Reality Sickness Questionnaire.docx
N/A
No
Fillable Fileable
Other-Installation_Removal of Wearable Markers
Wearable Markers_Study 1.docx
N/A
No
Fillable Fileable
Other-Installation_Removal of Wearable Markers
Wearable Markers_Study 2.docx
N/A
No
Fillable Fileable
Form and Instruction
0920-1441
NASA Task Load Index
Attachment D_NASA Task Load Index.docx
N/A
No
Fillable Fileable
Form and Instruction
0920-1441
Robot Trust Questionnaire
Attachment E_Human-Robot Trust Questionnaire.docx
N/A
No
Fillable Fileable
Form and Instruction
0920-1441
Post-Test Questionnaire
Attachment F_Post-Test Questionnaire.docx
N/A
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,052
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
2,104
0
2,104
0
0
0
Annual IC Time Burden (Hours)
250
0
250
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
NIOSH Sampling Plan
2. NIOSH DSR genIC_Sampling Plan_VR Demolition Robots.docx
12/12/2024
Recruitment Flyer
Attachment A_Recruitment Flyer.docx
12/12/2024
Record of Participation
Attachment H_Record of Test Subject Participation.docx
12/12/2024
Research Determination
Attachment I_23-NIOSH-11 041524 approval CamargoH.pdf
12/12/2024
Authorizing Legislation
Attachment J_OSH Act 1970_Authorizing Legislation.pdf
12/12/2024
0920-1441 GenIC Request Template
1. NIOSH DSR genIC Request_VR Demolition Robots.docx
12/12/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.