Information Collection

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

IC 278792 under ICR 202506-0920-001 · OMB 0920-1441.

Documents and Forms

Document Name Document Type
Form Motion Sickness pr 0920-26-0012 [NIOSH] Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in Lab/Simulator-based Setting Form
Form Informed Consent 0920-26-0012 [NIOSH] Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in Lab/Simulator-based Setting Form
Form Demographics/ cons 0920-26-0012 [NIOSH] Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in Lab/Simulator-based Setting Form
Form Post Test Question 0920-26-0012 [NIOSH] Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in Lab/Simulator-based Setting Form
Motion Sickness pr 0920-26-0012 Attachment 3 - Screening Questions for Participation.docx Form
Informed Consent 0920-26-0012 Attachment 5 - Consent to be in a Research Study.docx Form
Demographics/ cons 0920-26-0012 Attachment 7 - Data Collection Sheet_Clean.docx Form
Post Test Question 0920-26-0012 Attachment 8 - Post Test Questionnaire.docx Form
3. NIOSH DSR genIC_Request to Debit Hours_Police Cruiser Design_Clean.docx GenIC Request IC Document
Attachment 10 - OSH Act 1970_Authorizing Legislation.pdf Authorizing Legislation IC Document
Attachment 13 - Email PAD Approval.pdf PAD Approval IC Document
Attachment 12 - PIA for Privacy ACT Determination (PAD) CSPO 09102025 (2).pdf PIA for Privacy ACT Determination IC Document
Attachment 11 - IRB Approval.pdf IRB Approval IC Document
Attachment 1 - Recruitment Flyer.docx Recruitment IC Document
Attachment 2 - Sample Email to Police Contact.docx Sample Email to Police Contact IC Document
Attachment 9 - Record of Test Subject Participation.docx Attachment 9 - Record of Test Subject Participation IC Document
Attachment 6 - An Illustration of the Excel Datasheet_Clean.docx An Illustration of the Excel Datasheet IC Document
4. NIOSH DSR genIC_Sampling Plan_Police Cruiser Design_Clean.docx Sampling Plan IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NIOSH] Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in Lab/Simulator-based Setting	Agency IC Tracking Number:	0920-26-0012

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Motion Sickness prescreening Questionnaire	0920-26-0012	Attachment 3 - Screening Questions for Participation.docx	Yes	Yes	Fillable Fileable
Form	Informed Consent	0920-26-0012	Attachment 5 - Consent to be in a Research Study.docx	Yes	Yes	Fillable Fileable
Form	Demographics/ construction and robot experience	0920-26-0012	Attachment 7 - Data Collection Sheet_Clean.docx	Yes	Yes	Fillable Fileable
Form	Post Test Questionnaire	0920-26-0012	Attachment 8 - Post Test Questionnaire.docx	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: 230	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	230	230
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request	3. NIOSH DSR genIC_Request to Debit Hours_Police Cruiser Design_Clean.docx	01/27/2026
Authorizing Legislation	Attachment 10 - OSH Act 1970_Authorizing Legislation.pdf	01/20/2026
PAD Approval	Attachment 13 - Email PAD Approval.pdf	01/20/2026
PIA for Privacy ACT Determination	Attachment 12 - PIA for Privacy ACT Determination (PAD) CSPO 09102025 (2).pdf	01/20/2026
IRB Approval	Attachment 11 - IRB Approval.pdf	01/20/2026
Recruitment	Attachment 1 - Recruitment Flyer.docx	01/20/2026
Sample Email to Police Contact	Attachment 2 - Sample Email to Police Contact.docx	01/20/2026
Attachment 9 - Record of Test Subject Participation	Attachment 9 - Record of Test Subject Participation.docx	01/20/2026
An Illustration of the Excel Datasheet	Attachment 6 - An Illustration of the Excel Datasheet_Clean.docx	01/27/2026
Sampling Plan	4. NIOSH DSR genIC_Sampling Plan_Police Cruiser Design_Clean.docx	01/27/2026

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

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