Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise Form and Instruction
Exploration Team Survey Attachment_B_Exploration Team Survey.docx Form and Instruction
Briefing Officer Survey Attachment_C_Briefing Officer Survey_20201026.docx Form and Instruction
Team Trainer Interview Questions Attachment_D_Team Trainer Interview Questions.docx Form and Instruction
VRMineIMRCGenICRequest_20201026.docx GENIC Template with Project Overview IC Document
VRMineIMRC.OMB.SSA_20201026.docx Supporting Statement A IC Document
VRMineIMRC.OMB.SSB_20201026.docx Supporting Statement B IC Document
Attachment-A-FederalMineSafety&HealthAct1977_STARS.Submit.FINAL.pdf Federal Mine Safety and Health Act of 1977 IC Document
Attachment_E_Simulation Exercise Observation Form.docx Simulation Exercise Observation Form (for study team) IC Document
Attachment_F_In Person Recruitment Script.docx Recruitment Script IC Document
Attachment_G_Informed Consent.docx Informed Consent IC Document

Information Collection (IC) Details

IC Title:	Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise	Agency IC Tracking Number:	0920-21AQ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	n/a	Briefing Officer Survey	Attachment_C_Briefing Officer Survey_20201026.docx	No	Paper Only
Form and Instruction	n/a	Team Trainer Interview Questions	Attachment_D_Team Trainer Interview Questions.docx	No	Paper Only
Form and Instruction	n/a	Exploration Team Survey	Attachment_B_Exploration Team Survey.docx	No	Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	35	35
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	364	364

Documents for IC

Title	Document	Date Uploaded
GENIC Template with Project Overview	VRMineIMRCGenICRequest_20201026.docx	10/26/2020
Supporting Statement A	VRMineIMRC.OMB.SSA_20201026.docx	10/26/2020
Supporting Statement B	VRMineIMRC.OMB.SSB_20201026.docx	10/26/2020
Federal Mine Safety and Health Act of 1977	Attachment-A-FederalMineSafety&HealthAct1977_STARS.Submit.FINAL.pdf	10/26/2020
Simulation Exercise Observation Form (for study team)	Attachment_E_Simulation Exercise Observation Form.docx	10/26/2020
Recruitment Script	Attachment_F_In Person Recruitment Script.docx	10/26/2020
Informed Consent	Attachment_G_Informed Consent.docx	10/26/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.