Information Collection

Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting

IC 273728 under ICR 202506-0920-001 · OMB 0920-1441.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25CW Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-25CW Participant Recruitment Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-1441 Informed Consent Form_12JUN2025 Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-1441 Demographic Survey_12JUN2025 Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-25CW Robot Experience Questionnaire Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-25CW Comfort Level Questionnaire Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-25CW Post-Interaction Questionnaire Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-25CW Robot Attribute Ratings Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-25CW Record of Test Subject Participation Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
Form 0920-25CW Safety and Trust Robots Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Form
0920-25CW Participant Recruitment Attachment A_Participant Recruitment.docx	Form
0920-25CW Participant Recruitment Attachment A_Participant Recruitment.docx	Form
0920-1441 Informed Consent Form_02JUN2025 Attachment B_Informed Consent Form.docx	Form
0920-1441 Informed Consent Form_12JUN2025 Attachment B_Informed Consent_Upd.docx	Form
0920-1441 Demographic Survey_02JUN2025 Attachment C_Demographic Survey.docx	Form
0920-1441 Demographic Survey_12JUN2025 Attachment C_Demographic Survey.docx	Form
0920-25CW Robot Experience Questionnaire Attachment D_Robot Experience Questionnaire.docx	Form
0920-25CW Robot Experience Questionnaire Attachment D_Robot Experience Questionnaire.docx	Form
0920-25CW Comfort Level Questionnaire Attachment E_Comfort Level Questionnaire.docx	Form
0920-25CW Comfort Level Questionnaire Attachment E_Comfort Level Questionnaire.docx	Form
0920-25CW Post-Interaction Questionnaire Attachment F_Post-Interaction Questionnaire.docx	Form
0920-25CW Post-Interaction Questionnaire Attachment F_Post-Interaction Questionnaire.docx	Form
0920-25CW Robot Attribute Ratings Attachment G_Robot Attribute Ratings.docx	Form
0920-25CW Robot Attribute Ratings Attachment G_Robot Attribute Ratings.docx	Form
0920-25CW Record of Test Subject Participation Attachment H_Record of Test Subject Participation.docx	Form
0920-25CW Record of Test Subject Participation Attachment H_Record of Test Subject Participation.docx	Form
0920-25CW Safety and Trust Robots Attachment I - Record of IRB Approval_Safety and Trust Robots.JPG	Form
0920-25CW Safety and Trust Robots Attachment I - Record of IRB Approval_Safety and Trust Robots.JPG	Form
NIOSH DSR genIC_Request to Debit Hours - 24-NIOSH-12 - Mobile Robots.docx GenIC Request	IC Document
NIOSH DSR genIC_Request to Debit Hours - 24-NIOSH-12 - Mobile Robots.docx GenIC Request	IC Document
Change Request form EO 14168.docx Change Request Memo_02JUN2025	IC Document
Change Request form EO 14168.docx Change Request Memo_02JUN2025	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-25CW		Yes	Yes	Fillable Fileable
Form	0920-1441	N/A	Yes	Yes	Fillable Fileable
Form	0920-1441	N/A	Yes	Yes	Fillable Fileable
Form	0920-25CW		Yes	Yes	Fillable Fileable
Form	0920-25CW		Yes	Yes	Fillable Fileable
Form	0920-25CW		Yes	Yes	Fillable Fileable
Form	0920-25CW		Yes	Yes	Fillable Fileable
Form	0920-25CW		Yes	Yes	Fillable Fileable
Form	0920-25CW		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 801

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	801	801
Annual IC Time Burden (Hours)	119	119
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request		01/16/2025
Change Request Memo_02JUN2025		06/02/2025

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

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