Improving Safety of Human-Robot Interaction

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-20PR Robot Trust Questionnaire	Form and Instruction	New	Repair queued
Form 0920-20PR Robot Trust Questionnaire	Form and Instruction	New	Available
Form 0920-20PR Perceived Safety Questionnaire	Form and Instruction	New	Available
Form 0920-20PR Perceived Safety Questionnaire	Form and Instruction	New	Repair queued
Form 0920-20PR NASA Task Load Index	Form and Instruction	New	Available
Form 0920-20PR NASA Task Load Index	Form and Instruction	New	Repair queued
Form 0920-20PR Actual Experiment 2 – Collaborative Robot	Form and Instruction	New	Available
Form 0920-20PR Actual Experiment 2 – Collaborative Robot	Form and Instruction	New	Repair queued
Form 0920-20PR Actual Experiment 1 – Mobile Robot	Form and Instruction	New	Available
Form 0920-20PR Actual Experiment 1 – Mobile Robot	Form and Instruction	New	Available
Form 0920-20PR Robot Experience Questionnaire	Form and Instruction	New	Available
Form 0920-20PR Robot Experience Questionnaire	Form and Instruction	New	Available
Form 0920-20PR Virtual Reality Sickness Questionnaire	Form and Instruction	New	Available
Form 0920-20PR Virtual Reality Sickness Questionnaire	Form and Instruction	New	Available
Form 0920-20PR Participant Data Collection Form	Form and Instruction	New	Available
Form 0920-20PR Participant Data Collection Form	Form and Instruction	New	Available
Form 0920-20PR Consent Form	Form and Instruction	New	Available
Form 0920-20PR Informed Consent	Form and Instruction	New	Available
Form 0920-20PR Simulator Sickness Questionnaire	Form and Instruction	New	Available
Form 0920-20PR Simulator Sickness Susceptibility Questionnaire	Form and Instruction	New	Available
Attachment C - IRB Approval Letter.pdf	Supplementary Document	Uploaded 2020-12-22	Repair queued
Attachment B 60 day FRN.pdf	Supplementary Document	Uploaded 2020-12-22	Repair queued
Attachment A OSH Act of 1970.pdf	Supplementary Document	Uploaded 2020-12-22	Repair queued
SSB -Robot Safety ICR Section B final.docx	Supporting Statement B	Uploaded 2020-12-22	Repair queued
SSA - Robot Safety ICR Section A v2.docx	Supporting Statement A	Uploaded 2020-12-22	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
245038	Robot Trust Questionnaire	Form and Instruction	New	Robot Trust Questionnaire
245038	Robot Trust Questionnaire	Form and Instruction	New
245037	Perceived Safety Questionnaire	Form and Instruction	New	Perceived Safety Questionnaire
245037	Perceived Safety Questionnaire	Form and Instruction	New
245035	NASA Task Load Index	Form and Instruction	New	NASA Task Load Index
245035	NASA Task Load Index	Form and Instruction	New
245034	Actual Experiment 2 – Collaborative Robot	Form and Instruction	New	Actual Experiment 2 – Collaborative Robot
245034	Actual Experiment 2 – Collaborative Robot	Form and Instruction	New
245033	Actual Experiment 1 – Mobile Robot	Form and Instruction	New	Actual Experiment 1 – Mobile Robot
245033	Actual Experiment 1 – Mobile Robot	Form and Instruction	New
245032	Robot Experience Questionnaire	Form and Instruction	New	Robot Experience Questionnaire
245032	Robot Experience Questionnaire	Form and Instruction	New
245031	Virtual Reality Sickness Questionnaire	Form and Instruction	New	Virtual Reality Sickness Questionnaire
245031	Virtual Reality Sickness Questionnaire	Form and Instruction	New
245030	Participant Data Collection Form	Form and Instruction	New	Participant Data Collection Form
245030	Participant Data Collection Form	Form and Instruction	New
245029	Informed Consent	Form and Instruction	New	Consent Form
245029	Informed Consent	Form and Instruction	New
245028	Simulator Sickness Susceptibility Questionnaire	Form and Instruction	New	Simulator Sickness Questionnaire
245028	Simulator Sickness Susceptibility Questionnaire	Form and Instruction	New

ICR Details

OMB Control No: 0920-1342	ICR Reference No: 202012-0920-016
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20PR
Title: Improving Safety of Human-Robot Interaction
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/22/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/29/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2024	36 Months From Approved
Responses	7,289	0	0
Time Burden (Hours)	216	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this project is to determine how physical characteristics of robots (e.g. size and speed) impact human movement behavior, perceived workload, and trust, when working together in a shared workspace. Data will be used to refine voluntary consensus standards for industrial robot systems by improving the design and modeling of robots to reduce human-robot collisions.

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Authorizing Statute(s): PL: Pub.L. 91 - 596 20[a][1] Name of Law: OSHA 1970
  

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:
	85 FR 52604	08/26/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 7393	01/28/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Actual Experiment 1 – Mobile Robot	0920-20PR	Actual Experiment 1 – Mobile Robot
Actual Experiment 2 – Collaborative Robot	0920-20PR	Actual Experiment 2 – Collaborative Robot
Informed Consent	0920-20PR	Consent Form
NASA Task Load Index	0920-20PR	NASA Task Load Index
Participant Data Collection Form	0920-20PR	Participant Data Collection Form
Perceived Safety Questionnaire	0920-20PR	Perceived Safety Questionnaire
Robot Experience Questionnaire	0920-20PR	Robot Experience Questionnaire
Robot Trust Questionnaire	0920-20PR	Robot Trust Questionnaire
Simulator Sickness Susceptibility Questionnaire	0920-20PR	Simulator Sickness Questionnaire
Virtual Reality Sickness Questionnaire	0920-20PR	Virtual Reality Sickness Questionnaire

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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	7,289	0	0	7,289	0	0
Annual Time Burden (Hours)	216	0	0	216	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a New ICR.

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Annual Cost to Federal Government: $177,593

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

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? No

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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: 01/29/2021

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