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Agenda
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NIOSH] Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in Lab/Simulator-based Setting
Agency IC Tracking Number:
0920-26-0012
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
Motion Sickness prescreening Questionnaire
0920-26-0012
Attachment 3 - Screening Questions for Participation.docx
Yes
Yes
Fillable Fileable
Form
Informed Consent
0920-26-0012
Attachment 5 - Consent to be in a Research Study.docx
Yes
Yes
Fillable Fileable
Form
Demographics/ construction and robot experience
0920-26-0012
Attachment 7 - Data Collection Sheet_Clean.docx
Yes
Yes
Fillable Fileable
Form
Post Test Questionnaire
0920-26-0012
Attachment 8 - Post Test Questionnaire.docx
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:
230
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
230
0
230
0
0
0
Annual IC Time Burden (Hours)
41
0
41
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
GenIC Request
3. NIOSH DSR genIC_Request to Debit Hours_Police Cruiser Design_Clean.docx
01/27/2026
Authorizing Legislation
Attachment 10 - OSH Act 1970_Authorizing Legislation.pdf
01/20/2026
PAD Approval
Attachment 13 - Email PAD Approval.pdf
01/20/2026
PIA for Privacy ACT Determination
Attachment 12 - PIA for Privacy ACT Determination (PAD) CSPO 09102025 (2).pdf
01/20/2026
IRB Approval
Attachment 11 - IRB Approval.pdf
01/20/2026
Recruitment
Attachment 1 - Recruitment Flyer.docx
01/20/2026
Sample Email to Police Contact
Attachment 2 - Sample Email to Police Contact.docx
01/20/2026
Attachment 9 - Record of Test Subject Participation
Attachment 9 - Record of Test Subject Participation.docx
01/20/2026
An Illustration of the Excel Datasheet
Attachment 6 - An Illustration of the Excel Datasheet_Clean.docx
01/27/2026
Sampling Plan
4. NIOSH DSR genIC_Sampling Plan_Police Cruiser Design_Clean.docx
01/27/2026
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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