Information Collection

Computerized Neurocognitive Tests for Aeromedical Safety

IC 252241 under ICR 202203-2120-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Computerized Neurocognitive Tests for Aeromedical Safety	Form and Instruction
2 Demographics Questionnaire Part 2 - Demographics.pdf	Form and Instruction
3 Current State and Sleepiness Questionnaire Part 3 - CSS_and_SSS.pdf	Form and Instruction
4 Relevancy Questionnaire Part 4 - Relevancy.pdf	Form and Instruction
5 Final Survey Set Questionnaire Part 5 - Final Survey Set.pdf	Form and Instruction
1 Informed Consent (with Burden Statement) Questionnaire Part 1 - Burden Statement and Informed Consent.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 14 CFR 44507

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Demographics	Questionnaire Part 2 - Demographics.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Current State and Sleepiness	Questionnaire Part 3 - CSS_and_SSS.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	4	Relevancy	Questionnaire Part 4 - Relevancy.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	5	Final Survey Set	Questionnaire Part 5 - Final Survey Set.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	1	Informed Consent (with Burden Statement)	Questionnaire Part 1 - Burden Statement and Informed Consent.pdf	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	4,000	4,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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