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[NIOSH] Evaluation of robot to human communication designs

IC 273435 under ICR 202502-0920-005 · OMB 0920-1441.

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[NIOSH] Evaluation of robot to human communication designs 0920-1441-25CK
 
Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1441 Informed Consent Attachment B_Informed Consent Form.docx N/A No   Fillable Fileable
Form and Instruction 0920-1441 Robot Experience Questionnaire Attachment D_Robot Experience Questionnaire.docx N/A No   Fillable Fileable
Form and Instruction 0920-1441 Virtual Reality Experience Questionnaire Attachment E_Virtual Reality Experience Questionnaire.docx N/A No   Fillable Fileable
Form and Instruction 0920-1441 Virtual Reality Sickness Questionnaire Attachment F_Virtual Reality Sickness Questionnaire.docx N/A No   Fillable Fileable
Form and Instruction 0920-1441 Installation/Set-Up of Virtual Reality Controller Installation_Set-Up Virtual Reality Controller.docx N/A No   Fillable Fileable
Form and Instruction 0920-1441 Post Condition Questionnaire:Interface Modality, Safety, and Trust Attachment G_Post-Condition Questionnaire.docx N/A No   Fillable Fileable
Form and Instruction 0920-1441 Robot Evaluation Questionnaire Attachment H_Robot Evaluation Questionnaire.docx N/A No   Fillable Fileable
Form and Instruction 0920-1441 Demographic Survey Attachment C_Demographic Survey.docx N/A No   Fillable Fileable
Form and Instruction 0920-1441 Participant Recruitment Questionnaire Attachment J_Participant Recruitment Questionnaire.docx N/A No   Fillable Fileable
Form and Instruction n/a Demographic Survey (Amended) Attachment C_Demographic Survey.docx Yes Yes Fillable Fileable
Form and Instruction n/a Informed Consent (amended) Attachment B_Informed Consent Form.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

549 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,965 0 0 0 0 2,965
Annual IC Time Burden (Hours) 102 0 0 0 0 102
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Authorizing Legislation Attachment K - OSH Act 1970_Authorizing Legislation.pdf 12/30/2024
IRB Determination Attachment J - Record of IRB Approval_Evaluation of Comm Designs.JPG 12/30/2024
Test Subject Participation Record Attachment I_Record of Test Subject Participation.docx 12/30/2024
Sampling Plan 2. NIOSH DSR genIC_Sampling Plan - 24-NIOSH-02 - Evaluation of R-H comm design.docx 12/31/2024
Recruitment Flyer Attachment A_Recruitment Flyer.docx 01/08/2025
0920-1441 GenIC Request Template - Request to Debit Hours 1. NIOSH DSR genIC_Request to Debit Hours - 24-NIOSH-02 - Evaluation of R-H comm design.docx 01/08/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.