0920-1441 Virtual Reality Experience Questionnaire

Form Approved 

OMB No. 0920-1441 

Exp. Date 09/30/2027 

Attachment E: Virtual Reality Experience Questionnaire

VIRTUAL REALITY EXPERIENCE QUESTIONNAIRE

1. Prior experience with virtual reality.

1. Have you had any prior experience using any virtual reality devices? YES | NO

If you answered ‘No’ to the previous question, skip the following 3 questions.

2. What type of virtual reality device do you use or have previously used.

 Head mounted display or virtual reality headset (e.g., Oculus Rift, Meta Quest, HTC VIVE, etc.)

 Virtual reality CAVE

 Mixed reality glasses (e.g., Microsoft HoloLens, Google Glasses)

 Other: ________________

3. How long had you used the technology that you selected above?

_______________ hours/weeks/months/years

4. How often do you use the technology that you selected above?

 Never

 Hardly ever

 Occasionally

 Quite often

 Frequently

 Nearly all the time

Public reporting burden of this collection of information is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333. ATTN: PRA (0920-1441)