Information Collection

[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators

IC 272964 under ICR 202410-0920-024 · OMB 0920-1441.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1441 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1441 [NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction
Wearable Markers_Study 1.docx	Other-Installation_Removal of Wearab
Wearable Markers_Study 2.docx	Other-Installation_Removal of Wearab
0920-1441 Informed Consent Attachment G_Informed Consent Form.docx	Form and Instruction
0920-1441 Construction_Demolition Robot Experience Questionnaire Attachment B_ConstructionDemolition Robot Experience Questionnaire.docx	Form and Instruction
0920-1441 Virtual Reality Sickness Questionnaire Attachment C_Virtual Reality Sickness Questionnaire.docx	Form and Instruction
0920-1441 NASA Task Load Index Attachment D_NASA Task Load Index.docx	Form and Instruction
0920-1441 Robot Trust Questionnaire Attachment E_Human-Robot Trust Questionnaire.docx	Form and Instruction
0920-1441 Post-Test Questionnaire Attachment F_Post-Test Questionnaire.docx	Form and Instruction
2. NIOSH DSR genIC_Sampling Plan_VR Demolition Robots.docx NIOSH Sampling Plan	IC Document
Attachment A_Recruitment Flyer.docx Recruitment Flyer	IC Document
Attachment H_Record of Test Subject Participation.docx Record of Participation	IC Document
Attachment I_23-NIOSH-11 041524 approval CamargoH.pdf Research Determination	IC Document
Attachment J_OSH Act 1970_Authorizing Legislation.pdf Authorizing Legislation	IC Document
1. NIOSH DSR genIC Request_VR Demolition Robots.docx 0920-1441 GenIC Request Template	IC Document

IC Title:

[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators

Agency IC Tracking Number:

0920-1441-25BX

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	0920-1441	Informed Consent	Attachment G_Informed Consent Form.docx	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	Construction_Demolition Robot Experience Questionnaire	Attachment B_ConstructionDemolition Robot Experience Questionnaire.docx	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	Virtual Reality Sickness Questionnaire	Attachment C_Virtual Reality Sickness Questionnaire.docx	N/A	No	Fillable Fileable
Other-Installation_Removal of Wearable Markers			Wearable Markers_Study 1.docx	N/A	No	Fillable Fileable
Other-Installation_Removal of Wearable Markers			Wearable Markers_Study 2.docx	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	NASA Task Load Index	Attachment D_NASA Task Load Index.docx	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	Robot Trust Questionnaire	Attachment E_Human-Robot Trust Questionnaire.docx	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	Post-Test Questionnaire	Attachment F_Post-Test Questionnaire.docx	N/A	No	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,052

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	2,104	2,104
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NIOSH Sampling Plan	2. NIOSH DSR genIC_Sampling Plan_VR Demolition Robots.docx	12/12/2024
Recruitment Flyer	Attachment A_Recruitment Flyer.docx	12/12/2024
Record of Participation	Attachment H_Record of Test Subject Participation.docx	12/12/2024
Research Determination	Attachment I_23-NIOSH-11 041524 approval CamargoH.pdf	12/12/2024
Authorizing Legislation	Attachment J_OSH Act 1970_Authorizing Legislation.pdf	12/12/2024
0920-1441 GenIC Request Template	1. NIOSH DSR genIC Request_VR Demolition Robots.docx	12/12/2024

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