Consent form for economic collections

Economic Pretesting

CONSENT FORM

The U.S. Census Bureau routinely tests products used for collecting data or disseminating data in order to produce the best products possible.

You have volunteered to take part in a study to test [name of data collection–e.g., a draft of the Survey of Business Owners]. In order to have a complete record of your comments, your interview session will be audio-recorded. We plan to use the tapes to improve the survey. Only staff involved in this product design research will have access to the tapes.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have volunteered to participate in this U.S. Census Bureau product design study, and I give permission for my audio recordings to be used for the purposes stated above.

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Researcher’s Signature Participant’s Signature

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Printed Name Printed Name

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Date Date