Information Collection

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

IC 272964 under ICR 202502-0920-005 · OMB 0920-1441.

⚠️ Notice: This information collection may be referencing outdated material.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

2025-06-02 - No material or nonsubstantive change to a currently approved collection

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

0920-1441-25BX

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Electronic Capability
Form and Instruction	0920-1441	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	N/A	No	Fillable Fileable
Other-Installation_Removal of Wearable Markers		N/A	No	Fillable Fileable
Other-Installation_Removal of Wearable Markers		N/A	No	Fillable Fileable
Form and Instruction	0920-1441	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	N/A	No	Fillable Fileable
Form and Instruction	0920-1441	N/A	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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
	Requested	Previously Approved
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		12/12/2024
Recruitment Flyer		12/12/2024
Record of Participation		12/12/2024
Research Determination		12/12/2024
Authorizing Legislation		12/12/2024
0920-1441 GenIC Request Template		12/12/2024

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

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