[NIOSH] Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in Lab/Simulator-based Settings

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-25CW Safety and Trust Robots	Form	Unchanged	Available
Form 0920-25CW Record of Test Subject Participation	Form	Unchanged	Available
Form 0920-25CW Robot Attribute Ratings	Form	Unchanged	Repair queued
Form 0920-25CW Post-Interaction Questionnaire	Form	Unchanged	Available
Form 0920-25CW Comfort Level Questionnaire	Form	Unchanged	Available
Form 0920-25CW Robot Experience Questionnaire	Form	Unchanged	Repair queued
Form 0920-25CW Demographic Survey	Form	Unchanged	Repair queued
Form 0920-25CW Informed Consent Form	Form	Unchanged	Available
Form 0920-25CW Participant Recruitment	Form	Unchanged	Repair queued
Form 0920-25CW Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Repair queued
Informed Consent (amended)	Form and Instruction	Modified	Available
Demographic Survey (Amended)	Form and Instruction	Modified	Available
Form 0920-1441 Participant Recruitment Questionnaire	Form and Instruction	Modified	Available
Form 0920-1441 Demographic Survey	Form and Instruction	Modified	Available
Form 0920-1441 Robot Evaluation Questionnaire	Form and Instruction	Modified	Available
Form 0920-1441 Post Condition Questionnaire:Interface Modality, Safety, and Trust	Form and Instruction	Modified	Available
Form 0920-1441 Installation/Set-Up of Virtual Reality Controller	Form and Instruction	Modified	Available
Form 0920-1441 Virtual Reality Sickness Questionnaire	Form and Instruction	Modified	Available
Form 0920-1441 Virtual Reality Experience Questionnaire	Form and Instruction	Modified	Available
Form 0920-1441 Robot Experience Questionnaire	Form and Instruction	Modified	Available
Form 0920-1441 Informed Consent	Form and Instruction	Modified	Available
Form 0920-1441 [NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Repair queued
Form 0920-1441 Post-Test Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-1441 Robot Trust Questionnaire	Form and Instruction	Unchanged	Repair queued
Form 0920-1441 NASA Task Load Index	Form and Instruction	Unchanged	Available
Form 0920-1441 Virtual Reality Sickness Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-1441 Construction_Demolition Robot Experience Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-1441 Informed Consent	Form and Instruction	Unchanged	Available
Form 0920-1441 [NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction	Unchanged	Repair queued
Change Request form EO 14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-26	Available
Change Request form EO 14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-26	Repair queued
SSA_NIOSH_Lab with VR Pkg_Final.docx	Supplementary Document	Uploaded 2024-10-24	Available
SSA_NIOSH_Lab with VR Pkg_Final.docx	Supplementary Document	Uploaded 2024-10-24	Repair queued
SSA_NIOSH_Lab with VR Pkg_Change_Track.docx	Supplementary Document	Uploaded 2024-10-24	Available
SSA_NIOSH_Lab with VR Pkg_Change_Track.docx	Supplementary Document	Uploaded 2024-10-24	Repair queued
SSA_NIOSH_Lab with VR Pkg_Change_Clean.docx	Supplementary Document	Uploaded 2024-10-24	Available
SSA_NIOSH_Lab with VR Pkg_Change_Clean.docx	Supplementary Document	Uploaded 2024-10-24	Repair queued
NIOSH genIC_0920-1441_Request to Debit Hours.docx	Supplementary Document	Uploaded 2024-10-24	Available
NIOSH genIC_0920-1441_Request to Debit Hours.docx	Supplementary Document	Uploaded 2024-10-24	Repair queued
Change request justification 0920-1441.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-10-24	Available
Change request justification 0920-1441.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-10-24	Missing upstream
Attachment C - FRN_60-day 2024-08596.pdf	Supplementary Document	Uploaded 2024-07-19	Available
Attachment C - FRN_60-day 2024-08596.pdf	Supplementary Document	Uploaded 2024-07-19	Repair queued
Attachment B_MSHA Act 1977.pdf	Supplementary Document	Uploaded 2024-07-19	Available
Attachment B_MSHA Act 1977.pdf	Supplementary Document	Uploaded 2024-07-19	Repair queued
Attachment A - OSH Act 1970.pdf	Supplementary Document	Uploaded 2024-07-19	Available
Attachment A - OSH Act 1970.pdf	Supplementary Document	Uploaded 2024-07-19	Repair queued
2. SSB_NIOSH_Lab with VR Package_5.31.24.docx	Supporting Statement B	Uploaded 2024-07-19	Available
2. SSB_NIOSH_Lab with VR Package_5.31.24.docx	Supporting Statement B	Uploaded 2024-07-19	Repair queued
1. SSA_NIOSH_Lab with VR Pkg_5.31.24_final jjb_NIOSH_response_final.docx	Supporting Statement A	Uploaded 2024-08-30	Available
1. SSA_NIOSH_Lab with VR Pkg_5.31.24_final jjb_NIOSH_response_final.docx	Supporting Statement A	Uploaded 2024-08-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Safety and Trust Robots
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Record of Test Subject Participation
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Robot Attribute Ratings
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Post-Interaction Questionnaire
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Comfort Level Questionnaire
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Robot Experience Questionnaire
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Demographic Survey
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Informed Consent Form
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged	Participant Recruitment
273728	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form	Unchanged
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Informed Consent (amended)
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Demographic Survey (Amended)
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Participant Recruitment Questionnaire
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Demographic Survey
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Robot Evaluation Questionnaire
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Post Condition Questionnaire:Interface Modality, Safety, and Trust
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Installation/Set-Up of Virtual Reality Controller
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Virtual Reality Sickness Questionnaire
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Virtual Reality Experience Questionnaire
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Robot Experience Questionnaire
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified	Informed Consent
273435	[NIOSH] Evaluation of robot to human communication designs	Form and Instruction	Modified
272964	[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction	Unchanged	Post-Test Questionnaire
272964	[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction	Unchanged	Robot Trust Questionnaire
272964	[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction	Unchanged	NASA Task Load Index
272964	[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Other-Installation_Removal of Wearable Markers	Unchanged
272964	[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction	Unchanged	Virtual Reality Sickness Questionnaire
272964	[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction	Unchanged	Construction_Demolition Robot Experience Questionnaire
272964	[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction	Unchanged	Informed Consent
272964	[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1441	ICR Reference No: 202502-0920-005
Status: Historical Active	Previous ICR Reference No: 202410-0920-024
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-25-0028
Title: [NIOSH] Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in Lab/Simulator-based Settings
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/28/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2027	09/30/2027	09/30/2027
Responses	274,000	0	274,000
Time Burden (Hours)	205,002	0	205,002
Cost Burden (Dollars)	0	0	0

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Abstract: NIOSH is requesting a non-substantive change request for 0920-1441 by using the “Request for genIC Approval” Form when requesting to debit hours from the umbrella genIC package to reduce redundancy and unnecessary complexity that an additional Supporting Statement A would have on individual packages submitted. The Request for genIC Approval Form for 0920-1441 was initially submitted with the package as a form of Supporting Statement A but later removed to reduce extra work and redundancy. This change request includes very minor edits.

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Authorizing Statute(s): PL: Pub.L. 91 - 173 501(a) Name of Law: Mine Safety and Health Act of 1977
   US Code: 29 USC 669 Name of Law: Occupational Safety and Health Act of 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:
	89 FR 30372	04/23/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 58734	07/19/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	0920-25CW, 0920-25CW, 0920-25CW, 0920-25CW, 0920-25CW, 0920-25CW, 0920-25CW, 0920-25CW, 0920-25CW	Participant Recruitment ,   Informed Consent Form ,   Demographic Survey ,   Robot Experience Questionnaire ,   Comfort Level Questionnaire ,   Post-Interaction Questionnaire ,   Robot Attribute Ratings ,   Record of Test Subject Participation ,   Safety and Trust Robots
[NIOSH] Evaluation of robot to human communication designs	n/a, n/a, 0920-1441, 0920-1441, 0920-1441, 0920-1441, 0920-1441, 0920-1441, 0920-1441, 0920-1441, 0920-1441	Informed Consent ,   Robot Experience Questionnaire ,   Virtual Reality Experience Questionnaire ,   Virtual Reality Sickness Questionnaire ,   Installation/Set-Up of Virtual Reality Controller ,   Post Condition Questionnaire:Interface Modality, Safety, and Trust ,   Robot Evaluation Questionnaire ,   Demographic Survey ,   Participant Recruitment Questionnaire ,   Demographic Survey (Amended) ,   Informed Consent (amended)
[NIOSH] Identification of Hazards and Risk Factors for Demolition Robot Operators	0920-1441, 0920-1441, 0920-1441, 0920-1441, 0920-1441, 0920-1441	Informed Consent ,   Construction_Demolition Robot Experience Questionnaire ,   Virtual Reality Sickness Questionnaire ,   NASA Task Load Index ,   Robot Trust Questionnaire ,   Post-Test 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	274,000	274,000	0	0	0	0
Annual Time Burden (Hours)	205,002	205,002	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: New Generic Collection

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Annual Cost to Federal Government: $574,091

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.     Yes

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: 03/28/2025

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