Virtual Reality to Train and Assess Emergency Responders

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Mine Rescue/Continuous Mining participants: Pre/Post-Training Knowledge Test	Form and Instruction	Unchanged	Available
Mine Rescue/Longwall Mining participants: Pre/Post-Training Knowledge Test	Form and Instruction	Unchanged	Available
Mine Escape/Continuous Mining participants: Pre/Post-Training Knowledge Test	Form and Instruction	Unchanged	Available
Mine Escape/Longwall Mining participants: Pre/Post-Training Knowledge Test	Form and Instruction	Unchanged	Available
Mine Escape participants: Post-Training Questionnaire	Form and Instruction	Unchanged	Available
Revised Post-simulation Questionnaire	Form	Modified	Available
Mine Escape participants: Post-Simulation Questionnaire	Form and Instruction	Modified	Available
Mine Escape participants: Pre-Training Questionnaire	Form	Unchanged	Available
Mine Rescue participants: Post-Training Questionnaire	Form and Instruction	Unchanged	Available
Mine Rescue participants: Post-Simulation Questionnaire	Form and Instruction	Unchanged	Available
Mine Rescue participants: Pre-Training Questionnaire	Form	Unchanged	Available
Dr?ger BG4 participants: Post-Training Questionnaire	Form	Unchanged	Available
Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-04-10	Available
08_ICR Part B.docx	Supporting Statement B	Uploaded 2013-06-14	Available
Attachment E.pdf	Supplementary Document	Uploaded 2013-06-14	Available
Attachment D_updated.doc	Supplementary Document	Uploaded 2013-06-14	Available
Attachment A -(MINER ACT).pdf	Supplementary Document	Uploaded 2013-06-14	Available
02_ICR Part A_20130610.docx	Supporting Statement A	Uploaded 2013-06-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207513	Mine Rescue/Continuous Mining participants: Pre/Post-Training Knowledge Test	Form and Instruction	Unchanged	Mine Rescue/Continuous Mining participants: Pre/Post-Training Knowledge Test
207512	Mine Rescue/Longwall Mining participants: Pre/Post-Training Knowledge Test	Form and Instruction	Unchanged	Mine Rescue/Longwall Mining participants: Pre/Post-Training Knowledge Test
207511	Mine Escape/Continuous Mining participants: Pre/Post-Training Knowledge Test	Form and Instruction	Unchanged	Mine Escape/Continuous Mining participants: Pre/Post-Training Knowledge Test
207510	Mine Escape/Longwall Mining participants: Pre/Post-Training Knowledge Test	Form and Instruction	Unchanged	Mine Escape/Longwall Mining participants: Pre/Post-Training Knowledge Test
207509	Mine Escape participants: Post-Training Questionnaire	Form and Instruction	Unchanged	Mine Escape participants: Post-Training Questionnaire
207508	Mine Escape participants: Post-Simulation Questionnaire	Form	Modified	Revised Post-simulation Questionnaire
207508	Mine Escape participants: Post-Simulation Questionnaire	Form and Instruction	Modified	Mine Escape participants: Post-Simulation Questionnaire
207507	Mine Escape participants: Pre-Training Questionnaire	Form	Unchanged	Mine Escape participants: Pre-Training Questionnaire
207506	Mine Rescue participants: Post-Training Questionnaire	Form and Instruction	Unchanged	Mine Rescue participants: Post-Training Questionnaire
207505	Mine Rescue participants: Post-Simulation Questionnaire	Form and Instruction	Unchanged	Mine Rescue participants: Post-Simulation Questionnaire
207504	Mine Rescue Participants: Pre-Training Questionnaire	Form	Unchanged	Mine Rescue participants: Pre-Training Questionnaire
207503	Dr?ger BG4 participants: Post-Training Questionnaire	Form	Unchanged	Dr?ger BG4 participants: Post-Training Questionnaire

ICR Details

OMB Control No: 0920-0975	ICR Reference No: 201404-0920-006
Status: Historical Active	Previous ICR Reference No: 201306-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No: 19804
Title: Virtual Reality to Train and Assess Emergency Responders
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/16/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/15/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	07/31/2016	07/31/2016
Responses	510	0	510
Time Burden (Hours)	32	0	32
Cost Burden (Dollars)	0	0	0

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Abstract: This request for change is to edit a few questions on the post-simulation questionnaire for some respondents.

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Authorizing Statute(s): PL: Pub.L. 109 - 236 1 Name of Law: Mine Improvement and New Emergency Response Act of 2006 (Miner Act)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 12756	02/25/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 35933	06/14/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
Dr?ger BG4 participants: Post-Training Questionnaire	None	Dr?ger BG4 participants: Post-Training Questionnaire
Mine Escape participants: Post-Simulation Questionnaire	none, None	Mine Escape participants: Post-Simulation Questionnaire ,   Revised Post-simulation Questionnaire
Mine Escape participants: Post-Training Questionnaire	none	Mine Escape participants: Post-Training Questionnaire
Mine Escape participants: Pre-Training Questionnaire	None	Mine Escape participants: Pre-Training Questionnaire
Mine Escape/Continuous Mining participants: Pre/Post-Training Knowledge Test	none	Mine Escape/Continuous Mining participants: Pre/Post-Training Knowledge Test
Mine Escape/Longwall Mining participants: Pre/Post-Training Knowledge Test	none	Mine Escape/Longwall Mining participants: Pre/Post-Training Knowledge Test
Mine Rescue Participants: Pre-Training Questionnaire	None	Mine Rescue participants: Pre-Training Questionnaire
Mine Rescue participants: Post-Simulation Questionnaire	None	Mine Rescue participants: Post-Simulation Questionnaire
Mine Rescue participants: Post-Training Questionnaire	None	Mine Rescue participants: Post-Training Questionnaire
Mine Rescue/Continuous Mining participants: Pre/Post-Training Knowledge Test	none	Mine Rescue/Continuous Mining participants: Pre/Post-Training Knowledge Test
Mine Rescue/Longwall Mining participants: Pre/Post-Training Knowledge Test	none	Mine Rescue/Longwall Mining participants: Pre/Post-Training Knowledge Test

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	510	510	0	0	0	0
Annual Time Burden (Hours)	32	32	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $434,320

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/15/2014

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