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

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

Documents and Forms

Document Name Document Type
Form 0920-25CW Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting 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 Demographic Survey_02JUN2025 Attachment C_Demographic Survey.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 Post-Interaction Questionnaire Attachment F_Post-Interaction Questionnaire.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 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
Change Request form EO 14168.docx Change Request Memo_02JUN2025 IC Document

Information Collection (IC) Details

IC Title:	Direct Reading Methodologies, Sensors, and Robotics Technology Assessment in LabSimulator-based Setting	Agency IC Tracking Number:	0920-25CW

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-25CW	Participant Recruitment	Attachment A_Participant Recruitment.docx		Yes	Yes	Fillable Fileable
Form	0920-1441	Informed Consent Form_02JUN2025	Attachment B_Informed Consent Form.docx	N/A	Yes	Yes	Fillable Fileable
Form	0920-1441	Demographic Survey_02JUN2025	Attachment C_Demographic Survey.docx	N/A	Yes	Yes	Fillable Fileable
Form	0920-25CW	Robot Experience Questionnaire	Attachment D_Robot Experience Questionnaire.docx		Yes	Yes	Fillable Fileable
Form	0920-25CW	Comfort Level Questionnaire	Attachment E_Comfort Level Questionnaire.docx		Yes	Yes	Fillable Fileable
Form	0920-25CW	Post-Interaction Questionnaire	Attachment F_Post-Interaction Questionnaire.docx		Yes	Yes	Fillable Fileable
Form	0920-25CW	Robot Attribute Ratings	Attachment G_Robot Attribute Ratings.docx		Yes	Yes	Fillable Fileable
Form	0920-25CW	Record of Test Subject Participation	Attachment H_Record of Test Subject Participation.docx		Yes	Yes	Fillable Fileable
Form	0920-25CW	Safety and Trust Robots	Attachment I - Record of IRB Approval_Safety and Trust Robots.JPG		Yes	Yes	Fillable Fileable

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 %

	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

Title	Document	Date Uploaded
GenIC Request	NIOSH DSR genIC_Request to Debit Hours - 24-NIOSH-12 - Mobile Robots.docx	01/16/2025
Change Request Memo_02JUN2025	Change Request form EO 14168.docx	06/02/2025

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