Form 9 Realism Survey Screenshot

Quantification of Behavioral and Physiological Effects of Drugs Using a Mobile Scalable Device

Attachment 8 Screenshot of MSD -Realism Survey

Realism Survey - Screenshot

OMB: 0925-0692

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Attachment 8

Realism_ Electronic

Study name

Subject number

Date (mm/dd/yyyy)

Time (24 hour clock)

Expe rime nte r initials

NEXT

OMB Control #: 0925-xxxx Expiration Date: mm/dd/yyyy

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx). Do not return the
completed form to this address.

Ge ne ral Driv ing

Re sponse of the se at adjustme nt le v e rs
Not At All
Realis tic - 0

1

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

Re sponse of the mirror adjustme nt le v e rs
Not At All
Realis tic - 0

1

2

Re sponse of the door locks and handle s
Not At All
Realis tic - 0

1

Re sponse of the fans
Not At All
Realis tic - 0

1

Re sponse of the ge ar shift
Not At All
Realis tic - 0

1

Re sponse of the brake pe dal
Not At All
Realis tic - 0

1

Re sponse of acce le rator pe dal
Not At All
Realis tic - 0

1

Re sponse of the spe e dome te r
Not At All
Realis tic - 0

1

2

3

4

5

Com pletely
Realis tic - 6

NA

4

5

Com pletely
Realis tic - 6

NA

Re sponse of the ste e ring whe e l while driv ing straight
Not At All
Realis tic - 0

1

2

3

Re sponse of the ste e ring whe e l while driv ing on curv e s
Not At All
Realis tic - 0

2

3

4

5

Com pletely
Realis tic - 6

NA

1

2

3

4

5

Com pletely
Realis tic - 6

NA

1

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

1

Fe e l whe n acce le rating
Not At All
Realis tic - 0

Fe e l whe n braking
Not At All
Realis tic - 0

Ability to re ad road and warning signs
Not At All
Realis tic - 0

1

Appe arance of car inte rior
Not At All
Realis tic - 0

1

Appe arance of signs
Not At All
Realis tic - 0

1

Appe arance of roads and road markings
Not At All
Realis tic - 0

1

2

Appe arance of urban sce ne ry
Not At All
Realis tic - 0

1

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

Appe arance of rural sce ne ry
Not At All
Realis tic - 0

1

Appe arance of fre e way sce ne ry
Not At All
Realis tic - 0

1

Appe arance of inte rse ctions
Not At All
Realis tic - 0

1

Appe arance of he adlights
Not At All
Realis tic - 0

1

Appe arance of othe r v e hicle s
Not At All
Realis tic - 0

1

Appe arance of re ar-v ie w mirror image
Not At All
Realis tic - 0

1

2

3

4

5

Com pletely
Realis tic - 6

NA

1

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

Sound of the car
Not At All
Realis tic - 0

Sound of othe r v e hicle s
Not At All
Realis tic - 0

1

Ov e rall fe e l of the car whe n driv ing
Not At All
Realis tic - 0

1

2

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

Ov e rall similarity to re al driv ing
Not At All
Realis tic - 0

1

2

Ov e rall appe arance of driv ing sce ne s
Not At All
Realis tic - 0

1

2

BACK

NEXT

Publ i c repo rti ng burden for thi s col l ecti on of i nform ati on i s esti m ated to average 3 m i nutes per response, i ncl udi ng the ti m e for revi ewi ng i nstructi ons, searchi ng exi
sti ng data sources, gatheri ng and m ai ntai ni ng the data needed, and com pl eti ng and revi ewi ng the col l ecti on of i nform ati on. An agency m ay not conduct or
sponsor, and a person i s not requi red to respond to, a col l ecti on of i nform ati on unl ess i t di spl ays a currentl y val i d OMB control num ber. Send com m ents regardi ng
thi s burden esti m ate or any other aspect of thi s col l ecti on of i nform ati on, i ncl udi ng suggesti ons for reduci ng thi s burden, to: NIH, Proj ect Cl earance Branch, 6705
Rockl edge Dri ve, MSC 7974, Bethesda, MD 20892-7974, AT T N: PRA (0925-xxxx).

OMB Control #: 0925-xxxx Expi rati on Date: m m /dd/yyyy

Situational Driv ing

Fe e l of driv ing straight while going 25 mph
Not At All
Realis tic - 0

1

2

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

4

5

Com pletely
Realis tic - 6

NA

4

5

Com pletely
Realis tic - 6

NA

4

5

Com pletely
Realis tic - 6

NA

Fe e l of driv ing straight while going 35 mph
Not At All
Realis tic - 0

1

2

Fe e l of driv ing straight while going 55 mph
Not At All
Realis tic - 0

1

2

Fe e l of driv ing straight while going 65 mph
Not At All
Realis tic - 0

1

2

Fe e l of driv ing on a curv e d road while going 25 mph
Not At All
Realis tic - 0

1

2

3

Fe e l of driv ing on a curv e d road while going 55 mph
Not At All
Realis tic - 0

1

2

3

Fe e l of driv ing on a curv e d road while going 65 mph
Not At All
Realis tic - 0

1

2

3

Fe e l of acce le rating from a stoppe d position
Not At All
Realis tic - 0

1

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

5

Com pletely
Realis tic - 6

NA

Fe e l of braking to a stop
Not At All
Realis tic - 0

1

Pe rforming a 90 de gre e turn to the le ft while going 25 mph
Not At All
Realis tic - 0

1

2

3

4

Pe rforming a 90 de gre e turn to the right from a stoppe d position
Not At All
Realis tic - 0

1

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

2

3

4

5

Com pletely
Realis tic - 6

NA

Fe e l of driv ing on the fre e way
Not At All
Realis tic - 0

1

Fe e l of changing lane s on the fre e way
Not At All
Realis tic - 0

1

2

Fe e l of driv ing on a fre e way on/e xit ramp
Not At All
Realis tic - 0

1

Appe arance of grav e l road
Not At All
Realis tic - 0

1

Fe e l of driv ing on grav e l road
Not At All
Realis tic - 0

1

Ability to stop the v e hicle
Not At All
Realis tic - 0

1

2

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

3

4

5

Com pletely
Realis tic - 6

NA

Ability to re spond to othe r v e hicle s
Not At All
Realis tic - 0

1

2

Ability to ke e p straight in your lane
Not At All
Realis tic - 0

1

2

Ability to re spond at inte rse ctions
Not At All
Realis tic - 0

1

2

BACK

NEXT

Publ i c repo rti ng burden for thi s col l ecti on of i nform ati on i s esti m ated to average 3 m i nutes per response, i ncl udi ng the ti m e for revi ewi ng i nstructi ons, searchi ng exi
sti ng data sources, gatheri ng and m ai ntai ni ng the data needed, and com pl eti ng and revi ewi ng the col l ecti on of i nform ati on. An agency m ay not conduct or
sponsor, and a person i s not requi red to respond to, a col l ecti on of i nform ati on unl ess i t di spl ays a currentl y val i d OMB control num ber. Send com m ents regardi ng
thi s burden esti m ate or any other aspect of thi s col l ecti on of i nform ati on, i ncl udi ng suggesti ons for reduci ng thi s burden, to: NIH, Proj ect Cl earance Branch, 6705
Rockl edge Dri ve, MSC 7974, Bethesda, MD 20892-7974, AT T N: PRA (0925-xxxx).

OMB Control #: 0925-xxxx Expi rati on Date: m m /dd/yyyy

Thank you for comple ting our que stionnaire .
At this time , ple ase notify the e xpe rime nte r that you hav e finishe d.

BACK

NEXT

Publ i c repo rti ng burden for thi s col l ecti on of i nform ati on i s esti m ated to average 3 m i nutes per response, i ncl udi ng the ti m e for revi ewi ng i nstructi ons, searchi ng exi
sti ng data sources, gatheri ng and m ai ntai ni ng the data needed, and com pl eti ng and revi ewi ng the col l ecti on of i nform ati on. An agency m ay not conduct or
sponsor, and a person i s not requi red to respond to, a col l ecti on of i nform ati on unl ess i t di spl ays a currentl y val i d OMB control num ber. Send com m ents regardi ng
thi s burden esti m ate or any other aspect of thi s col l ecti on of i nform ati on, i ncl udi ng suggesti ons for reduci ng thi s burden, to: NIH, Proj ect Cl earance Branch, 6705
Rockl edge Dri ve, MSC 7974, Bethesda, MD 20892-7974, AT T N: PRA (0925-xxxx).

OMB Control #: 0925-xxxx Expi rati on Date: m m /dd/yyyy

Expe rime nte r initials

BACK

NEXT

Publ i c repo rti ng burden for thi s col l ecti on of i nform ati on i s esti m ated to average 3 m i nutes per response, i ncl udi ng the ti m e for revi ewi ng i nstructi ons, searchi ng exi
sti ng data sources, gatheri ng and m ai ntai ni ng the data needed, and com pl eti ng and revi ewi ng the col l ecti on of i nform ati on. An agency m ay not conduct or
sponsor, and a person i s not requi red to respond to, a col l ecti on of i nform ati on unl ess i t di spl ays a currentl y val i d OMB control num ber. Send com m ents regardi ng
thi s burden esti m ate or any other aspect of thi s col l ecti on of i nform ati on, i ncl udi ng suggesti ons for reduci ng thi s burden, to: NIH, Proj ect Cl earance Branch, 6705
Rockl edge Dri ve, MSC 7974, Bethesda, MD 20892-7974, AT T N: PRA (0925-xxxx).

OMB Control #: 0925-xxxx Expi rati on Date: m m /dd/yyyy

We thank you for your tim e s pent taking this s urvey.
Your res pons e has been recorded.

Publ i c repo rti ng burden for thi s col l ecti on of i nform ati on i s esti m ated to average 3 m i nutes per response, i ncl udi ng the ti m e for revi ewi ng i nstructi ons, searchi ng exi
sti ng data sources, gatheri ng and m ai ntai ni ng the data needed, and com pl eti ng and revi ewi ng the col l ecti on of i nform ati on. An agency m ay not conduct or
sponsor, and a person i s not requi red to respond to, a col l ecti on of i nform ati on unl ess i t di spl ays a currentl y val i d OMB control num ber. Send com m ents regardi ng
thi s burden esti m ate or any other aspect of thi s col l ecti on of i nform ati on, i ncl udi ng suggesti ons for reduci ng thi s burden, to: NIH, Proj ect Cl earance Branch, 6705
Rockl edge Dri ve, MSC 7974, Bethesda, MD 20892-7974, AT T N: PRA (0925-xxxx).


File Typeapplication/pdf
AuthordeAlmeida-Morris, Genevieve (NIH/NIDA) [E]
File Modified2013-07-31
File Created2013-07-31

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