Attach E-2

Attachment E-2. Assurance of Confidentiality and Informed Consent for Focus groups

OMB# 0925-xxxx

Expiry Date: xx/xxxx

[The following wording is substituted into Attachment E-1 (Assurance of Confidentiality and Informed Consent Templates for Cognitive Interview), to reflect group-interview as opposed to individual- interview.]

If you agree to take part in this test, you will be part of a discussion group about new questions for [FILL survey name here].

The discussion group will show us how to improve the questions for this survey. In the future, we may also study the group interview along with interviews from other projects. This type of study will teach us about the different kinds of problems people have answering survey questions. The study will help us write better questions in the future.

Procedures

A group leader will ask you to share your thoughts and ideas about the questions with other people in the group. You will not be asked your personal answers to the questions. We will ask you to pick a name and put it on a name tag. You do not have to use your real name.

The discussion will last XX minutes, and we will give you $XX.

You may leave the discussion group at any time. You may also choose not to discuss any question for any reason. While the discussion is going on, researchers from [FILL AGENCY] who are working with us on this project may watch the discussion.

Recordings

We plan to video/audio¹ record the discussion. The recording allows us to more carefully study the questions. At the bottom of this form, you will be asked if you are willing to have the discussion recorded. When the discussion is finished, you or anyone in the group may watch/listen to the recording. Since recording is essential for this project and you do not wish to be recorded, you should not join the discussion. If you decide that you do not want to be recorded, you will still receive the full XX.