Nutrition Education Public Service Advertising (PSA) Campaign - Confidentiality Response

Miami & Los Angeles

Attachment 4

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required to complete this information collection is estimated to average 35 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Nutrition Education Public Service Advertising (PSA) Campaign

OMB Blanket Clearance No. 0584-0524

Confidentiality Agreement

Individual Interviews

I understand that all information revealed during this interview will be held strictly confidential by the research team collecting this information. I understand that my name will not be used.

I hereby agree to keep confidential all information discussed during the interview I am participating in (location, date, time) being conducted by Saatchi & Saatchi on behalf of the USDA Food and Nutrition Service.

Signature of Participant Date

Name of Participant (please print)

The above OMB Statement and Confidentiality Agreement are shared with all participants during the telephone screening, and in all interviews.