Cognitive Research on the National Crime Victimization Survey, Internet Predation Questions

CONSENT FORM

Internet Predation Questions in the National Crime Victimization Survey

______________________________ [CHILD’S NAME] has my permission to take part in the evaluation of Internet Predation questions in the National Crime Victimization Survey. In order to have a complete record of his/her comments, this session will be audio-taped. We plan to use the tapes to improve the questionnaire. Staff directly involved in the questionnaire design research project will have access to the tapes. Your child’s participation is voluntary and his/her answers will remain strictly confidential

This study is being conducted under the authority of Title 13 USC, Section 8. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have agreed to allow my child to participate in this Census Bureau questionnaire design study, and I give permission for the tapes to be used for the purposes stated above.

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Parent's Signature Researcher's Signature

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Printed Name Printed Name

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