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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting
Agency IC Tracking Number:
0920-25CW
IC Status:
Unchanged
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
0920-25CW
Participant Recruitment
Attachment A_Participant Recruitment.docx
Yes
Yes
Fillable Fileable
Form
0920-25CW
Informed Consent Form
Attachment B_Informed Consent Form.docx
Yes
Yes
Fillable Fileable
Form
0920-25CW
Demographic Survey
Attachment C_Demographic Survey.docx
Yes
Yes
Fillable Fileable
Form
0920-25CW
Robot Experience Questionnaire
Attachment D_Robot Experience Questionnaire.docx
Yes
Yes
Fillable Fileable
Form
0920-25CW
Comfort Level Questionnaire
Attachment E_Comfort Level Questionnaire.docx
Yes
Yes
Fillable Fileable
Form
0920-25CW
Post-Interaction Questionnaire
Attachment F_Post-Interaction Questionnaire.docx
Yes
Yes
Fillable Fileable
Form
0920-25CW
Robot Attribute Ratings
Attachment G_Robot Attribute Ratings.docx
Yes
Yes
Fillable Fileable
Form
0920-25CW
Record of Test Subject Participation
Attachment H_Record of Test Subject Participation.docx
Yes
Yes
Fillable Fileable
Form
0920-25CW
Safety and Trust Robots
Attachment I - Record of IRB Approval_Safety and Trust Robots.JPG
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
801
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
801
0
0
0
0
801
Annual IC Time Burden (Hours)
119
0
0
0
0
119
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
GenIC Request
NIOSH DSR genIC_Request to Debit Hours - 24-NIOSH-12 - Mobile Robots.docx
01/16/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.