Information Collection

Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise

IC 247214 under ICR 201912-0920-003 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-21EY VRMine_Attachment_B_Exploration Team Survey Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise	Form and Instruction
Form 0920-21EY VRMine_Attachment_C_Briefing Officer Survey Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise	Form and Instruction
Form 0920-21EY Team Trainers Survery Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise	Form and Instruction
0920-21EY VRMine_Attachment_B_Exploration Team Survey VRMine_Attachment_B_Exploration Team Survey.docx	Form and Instruction
0920-21EY VRMine_Attachment_C_Briefing Officer Survey VRMine_Attachment_C_Briefing Officer Survey.docx	Form and Instruction
0920-21EY Team Trainers Survery VRMine_Part 2- Attachment D.pdf	Form and Instruction
VRMine.OMB.SSA.docx SSA	IC Document
VRMine.OMB.SSB.docx SSB	IC Document
VRMine_Attachment_A_Authorizing-Legislation-FederalMineSafety&HealthAct1977_No Change.pdf Authorizing-Legislation	IC Document
VRMine_Attachment_E_Simulation Observation Form.docx VRMine_Attachment_E_Simulation Observation Form	IC Document
VRMine_Attachment_F_In Person Recruitment Script.docx VRMine_Attachment_F_In Person Recruitment Script	IC Document
VRMine_Attachment_G_Informed Consent.docx VRMine_Attachment_G_Informed Consent	IC Document
VRMine_HSRB_AMENDMENT_VRMine Evaluation Protocol Amend for Generalized Data Collection Sites 20210108.docx Evaluation Protocol	IC Document
VRMineIMRCGenICRequest_20210421.docx GenIC Request for Approval	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise

Agency IC Tracking Number:

0920-21EY

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-21EY	Yes	Yes	Fillable Fileable
Form and Instruction	0920-21EY	Yes	Yes	Fillable Fileable
Form and Instruction	0920-21EY	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	35	35
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA		05/05/2021
SSB		05/05/2021
Authorizing-Legislation		05/05/2021
VRMine_Attachment_E_Simulation Observation Form		05/05/2021
VRMine_Attachment_F_In Person Recruitment Script		05/05/2021
VRMine_Attachment_G_Informed Consent		05/05/2021
Evaluation Protocol		05/05/2021
GenIC Request for Approval		05/05/2021

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

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