Attachment I – Informed Consents OMB: 0925-0046-17
Expiration Date: 1/31/2010
Attachment I: Informed Consents
Informed Consents for:
Interview
Interview with Federal Employee
Focus Group
Focus Group with Federal Employee
Triad Interview with Federal Employee
Informed Consent for Interview:
Consent to Participate in Research
Title of Research: Process and Needs Assessment Evaluation of the HINTS Program
You are being asked to participate in a research study. Before you decide if you want to take part in this study, please read this Informed Consent form so that you understand what the study is about and what you will be asked to do. The purpose of this form is to identify who can be in the study, the risks and benefits of the study, how we will protect your information should you choose to participate, and whom you can call if you have questions. Please ask the researcher to explain anything you do not understand before you make your decision.
This study is paid for by the National Cancer Institute (NCI). The research study is being conducted by RTI International, a non-profit social science research organization whose headquarters are in Research Triangle Park, North Carolina. The purpose of this study is to gain insight about the reach of and satisfaction with the HINTS Program, a research tool funded by the NCI used to gather and disseminate information on cancer and cancer-related behaviors. NCI is interested in gathering feedback from a variety of different users regarding the relevance, quality, and scope of the data collected. Individuals recruited for the study are those that use HINTS or other research tools to analyze and develop cancer-related findings and those who use the findings from HINTS data or other cancer data for policies, programs, and practices.
The procedure is an interview lasting approximately one hour. You will be asked about your experience and satisfaction with the HINTS data and to provide feedback and suggestions about the HINTS program.
Your participation in the interview will take about one hour.
The questions we ask are not meant to be sensitive. Still, there is a chance that you may feel discomfort about some of the questions we ask. Your participation in this study is voluntary. You may choose not to answer any question that you do not want to answer and you can stop participating at any time.
Your Benefits: You may gain knowledge of the HINTS program that will aid you in your future research. There are no other direct benefits to you from participating in this study.
Benefits for Others:
The study results may help RTI improve its evaluation of the HINTS
Program by identifying ways to improve the protocol guides to
accurately tap users’ insight.
In appreciation for your time, you will receive a $50 gift certificate to Amazon. You will receive the gift certificate by email after the interview is completed.
Many precautions have been taken to protect your information. Your identifiable information, the audio recording and notes from the interview will be kept by the evaluation contractor, RTI, under lock and key. Identifiable information such as names and phone numbers will be kept separate from the interview notes and will not be included in a report or in subsequent publications or presentations. The findings from the interviews will be reported in summary form so that the participants cannot be identified.
Each interview will be audiotaped using cassette recorders or digital recorders. RTI will retain a copy of the audio files and/or cassettes and destroy them within a year of the project’s end. All tapes will be stored in a locked cabinet at RTI. Digital files will be kept on password-protected laptop computers and a share drive to which only RTI team members have access.
The Institutional Review Board (IRB) at RTI International has reviewed this research. An IRB is a group of people who are responsible for assuring that the rights of study participants in research are protected. The IRB may review the records of your participation in this research to assure that proper procedures were followed.
We will not contact you in the future.
Your Rights
Your decision to take part in this research study is completely voluntary. You can refuse any part of the study and you can stop participating at any time. You can refuse to answer any question. If you decide to participate and later change your mind, you will not be contacted again or asked for further information.
Your Questions
If you have any questions about the study, you may call Linda Squiers at 301-570-8088 or Marjorie Margolis at 1-800-334-8571 (extension 2-7184). If you have any questions about your rights as a study participant, you may call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number).
YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP.
Your signature below indicates that you have been read the information provided above, have received answers to your questions, and have freely decided to participate in this research. By agreeing to participate in this research, you are not giving up any of your legal rights.
___________________________________ _ ______________
Signature of Participant Date
____________________________________ __
Printed Name of Participant
Informed Consent for Interview with Federal Employees:
Consent to Participate in Research
Title of Research: Process and Needs Assessment Evaluation of the HINTS Program
You are being asked to participate in a research study. Before you decide if you want to take part in this study, please read this Informed Consent form so that you understand what the study is about and what you will be asked to do. The purpose of this form is to identify who can be in the study, the risks and benefits of the study, how we will protect your information should you choose to participate, and whom you can call if you have questions. Please ask the researcher to explain anything you do not understand before you make your decision.
This study is paid for by the National Cancer Institute. The research study is being conducted by RTI International, a non-profit social science research organization whose headquarters are in Research Triangle Park, North Carolina. The purpose of this study is to gain insight about the reach of and satisfaction with the HINTS Program, a research tool funded by the NCI used to gather and disseminate information on cancer and cancer-related behaviors. NCI is interested in gathering feedback from a variety of different users regarding the relevance, quality and scope of the data collected. Individuals recruited for the study are those that use HINTS or other research tools to analyze and develop cancer-related findings and those who use the findings from HINTS data or other cancer data for policies, programs, and practices.
The procedure is an interview lasting approximately one hour. You will be asked about your experience and satisfaction with the HINTS data and to provide feedback and suggestions about the HINTS program.
Your participation in the interview will take about one hour.
The questions we ask are not meant to be sensitive. Still, there is a chance that you may feel discomfort about some of the questions we ask. Your participation in this study is voluntary. You may choose not to answer any question that you do not want to answer and you can stop participating at any time.
Your Benefits: You may gain knowledge of the HINTS program that will aid you in your future research. There are no other direct benefits to you from participating in this study.
Benefits for Others:
The study results may help RTI improve its evaluation of the HINTS
Program by identifying ways to improve the protocol guides to
accurately tap users’ insight.
You will not receive compensation for participation in this interview.
Many precautions have been taken to protect your information. Your identifiable information, the audio recording and notes from the interview will be kept by the evaluation contractor, RTI, under lock and key. Identifiable information such as names and phone numbers will be kept separate from the interview notes and will not be included in a report or in subsequent publications or presentations. The findings from the interviews will be reported in summary form so that the participants cannot be identified.
Each interview will be audio-taped using cassette recorders or digital recorders. RTI will retain a copy of the audio files and/or cassettes and destroy them within a year of the project’s end. All tapes will be stored in a locked cabinet at RTI. Digital files will be kept on password-protected laptop computers and a share drive to which only RTI team members have access.
The Institutional Review Board (IRB) at RTI International has reviewed this research. An IRB is a group of people who are responsible for assuring that the rights of participants in research are protected. The IRB may review the records of your participation in this research to assure that proper procedures were followed.
We will not contact you in the future.
Your Rights
Your decision to take part in this research study is completely voluntary. You can refuse any part of the study and you can stop participating at any time. You can refuse to answer any question. If you decide to participate and later change your mind, you will not be contacted again or asked for further information.
Your Questions
If you have any questions about the study, you may call Linda Squiers at 301-570-8088or Marjorie Margolis at 1-800-334-8571 (extension 2-7184). If you have any questions about your rights as a study participant, you may call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number).
YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP.
Your signature below indicates that you have been read the information provided above, have received answers to your questions, and have freely decided to participate in this research. By agreeing to participate in this research, you are not giving up any of your legal rights.
___________________________________ _ ______________
Signature of Participant Date
_____________________________________
Printed Name of Participant
Informed Consent for Focus Groups:
Consent to Participate in Research
Title of Research: Process and Needs Assessment Evaluation of the HINTS Program
You are being asked to participate in a research study. Before you decide if you want to take part in this study, please read this Informed Consent form so that you understand what the study is about and what you will be asked to do. The purpose of this form is to identify who can be in the study, the risks and benefits of the study, how we will protect your information should you choose to participate, and whom you can call if you have questions. Please ask the researcher to explain anything you do not understand before you make your decision.
This study is paid for by the National Cancer Institute. The research study is being conducted by RTI International, a non-profit social science research organization whose headquarters are in Research Triangle Park, North Carolina. The purpose of this study is to gain insight about the reach of and satisfaction with the HINTS Program, a research tool funded by the NCI used to gather and disseminate information on cancer and cancer-related behaviors. NCI is interested in gathering feedback from a variety of different users regarding the relevance, quality and scope of the data collected. Individuals recruited for the study are those that use HINTS or other research tools to analyze and develop cancer-related findings and those who use the findings from HINTS data or other cancer data for policies, programs, and practices.
The procedure is a focus group with other stakeholders that NCI serves through the HINTS Program. The focus group will last approximately 90 minutes. You will be asked about your experience and satisfaction with the HINTS data and to provide feedback and suggestions about the HINTS program.
Your participation in the focus group will take about 90 minutes.
The questions we ask are not meant to be sensitive. Still, there is a chance that you may feel discomfort about some of the questions we ask. Your participation in this study is voluntary. You may choose not to answer any question that you do not want to answer and you can stop participating at any time.
Your Benefits: You may gain knowledge of the HINTS program that will aid you in your future research. There are no other direct benefits to you from participating in this study.
Benefits for Others:
The study results may help RTI improve its evaluation of the HINTS
Program by identifying ways to improve the protocol guides to
accurately tap users’ insight.
In appreciation for your time, you will receive a $50 gift certificate to Amazon. You will receive the gift certificate by email after the focus group is completed.
Many precautions have been taken to protect your information. Your identifiable information, the audio recording and notes from the interview will be kept by the evaluation contractor, RTI, under lock and key. Identifiable information such as names and phone numbers will be kept separate from the interview notes and will not be included in a report or in subsequent publications or presentations. The findings from the interviews will be reported in summary form so that the participants cannot be identified.
Each focus group will be audio-taped using cassette recorders or digital recorders. RTI will retain a copy of the audio files and/or cassettes and destroy them within a year of the project’s end. All tapes will be stored in a locked cabinet at RTI. Digital files will be kept on password-protected laptop computers and a share drive to which only RTI team members have access.
The Institutional Review Board (IRB) at RTI International has reviewed this research. An IRB is a group of people who are responsible for assuring that the rights of participants in research are protected. The IRB may review the records of your participation in this research to assure that proper procedures were followed.
We will not contact you in the future.
Your Rights
Your decision to take part in this research study is completely voluntary. You can refuse any part of the study and you can stop participating at any time. You can refuse to answer any question. If you decide to participate and later change your mind, you will not be contacted again or asked for further information.
Your Questions
If you have any questions about the study, you may call Linda Squiers at 301-570-8088or Marjorie Margolis at 1-800-334-8571 (extension 2-7184). If you have any questions about your rights as a study participant, you may call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number).
YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP.
Your signature below indicates that you have been read the information provided above, have received answers to your questions, and have freely decided to participate in this research. By agreeing to participate in this research, you are not giving up any of your legal rights.
___________________________________ _ ______________
Signature of Participant Date
____________________________________ __
Printed Name of Participant
Informed Consent for Focus Groups with Federal Employees:
Consent to Participate in Research
Title of Research: Process and Needs Assessment Evaluation of the HINTS Program
You are being asked to participate in a research study. Before you decide if you want to take part in this study, please read this Informed Consent form so that you understand what the study is about and what you will be asked to do. The purpose of this form is to identify who can be in the study, the risks and benefits of the study, how we will protect your information should you choose to participate, and whom you can call if you have questions. Please ask the researcher to explain anything you do not understand before you make your decision.
This study is paid for by the National Cancer Institute. The research study is being conducted by RTI International, a non-profit social science research organization whose headquarters are in Research Triangle Park, North Carolina. The purpose of this study is to gain insight about the reach of and satisfaction with the HINTS Program, a research tool funded by the NCI used to gather and disseminate information on cancer and cancer-related behaviors. NCI is interested in gathering feedback from a variety of different users regarding the relevance, quality and scope of the data collected. Individuals recruited for the study are those that use HINTS or other research tools to analyze and develop cancer-related findings and those who use the findings from HINTS data or other cancer data for policies, programs, and practices.
The procedure is a focus group with other stakeholders that NCI serves through the HINTS Program. The focus group will last approximately 90 minutes. You will be asked about your experience and satisfaction with the HINTS data and to provide feedback and suggestions about the HINTS program.
Your participation in the focus group will take about 90 minutes.
The questions we ask are not meant to be sensitive. Still, there is a chance that you may feel discomfort about some of the questions we ask. Your participation in this study is voluntary. You may choose not to answer any question that you do not want to answer and you can stop participating at any time.
Your Benefits: You may gain knowledge of the HINTS program that will aid you in your future research. There are no other direct benefits to you from participating in this study.
Benefits for Others:
The study results may help RTI improve its evaluation of the HINTS
Program by identifying ways to improve the protocol guides to
accurately tap users’ insight.
You will not receive any compensation for participation in the focus group.
Many precautions have been taken to protect your information. Your identifiable information, the audio recording and notes from the interview will be kept by the evaluation contractor, RTI, under lock and key. Identifiable information such as names and phone numbers will be kept separate from the interview notes and will not be included in a report or in subsequent publications or presentations. The findings from the interviews will be reported in summary form so that the participants cannot be identified.
Each focus group will be audio-taped using cassette recorders or digital recorders. RTI will retain a copy of the audio files and/or cassettes and destroy them within a year of the project’s end. All tapes will be stored in a locked cabinet at RTI. Digital files will be kept on password-protected laptop computers and a share drive to which only RTI team members have access.
The Institutional Review Board (IRB) at RTI International has reviewed this research. An IRB is a group of people who are responsible for assuring that the rights of participants in research are protected. The IRB may review the records of your participation in this research to assure that proper procedures were followed.
We will not contact you in the future.
Your Rights
Your
decision to take part in this research study is completely voluntary.
You can refuse any part of the study and you can stop participating
at any time. You can refuse to answer any question. If you decide to
participate and later change your mind, you will not be contacted
again or asked for further information.
Your Questions
If you have any questions about the study, you may call Linda Squiers at 301-570-8088 or Marjorie Margolis at 1-800-334-8571 (extension 2-7184). If you have any questions about your rights as a study participant, you may call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number).
YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP.
Your signature below indicates that you have been read the information provided above, have received answers to your questions, and have freely decided to participate in this research. By agreeing to participate in this research, you are not giving up any of your legal rights.
___________________________________ _ ______________
Signature of Participant Date
____________________________________ __
Printed Name of Participant
Informed Consent for Triad Interviews:
Consent to Participate in Research
Title of Research: Process and Needs Assessment Evaluation of the HINTS Program
You are being asked to participate in a research study. Before you decide if you want to take part in this study, please read this Informed Consent form so that you understand what the study is about and what you will be asked to do. The purpose of this form is to identify who can be in the study, the risks and benefits of the study, how we will protect your information should you choose to participate, and whom you can call if you have questions. Please ask the researcher to explain anything you do not understand before you make your decision.
This study is paid for by the National Cancer Institute. The research study is being conducted by RTI International, a non-profit social science research organization whose headquarters are in Research Triangle Park, North Carolina. The purpose of this study is to gain insight about the reach of and satisfaction with the HINTS Program, a research tool funded by the NCI used to gather and disseminate information on cancer and cancer-related behaviors. NCI is interested in gathering feedback from a variety of different users regarding the relevance, quality and scope of the data collected. Individuals recruited for the study are those that use HINTS or other research tools to analyze and develop cancer-related findings and those who use the findings from HINTS data or other cancer data for policies, programs, and practices.
The procedure is a triad interview lasting approximately 90 minutes. You will be asked about your experience and satisfaction with the HINTS data and to provide feedback and suggestions about the HINTS program.
Your participation in the triad interview will take about one hour.
The questions we ask are not meant to be sensitive. Still, there is a chance that you may feel discomfort about some of the questions we ask. Your participation in this study is voluntary. You may choose not to answer any question that you do not want to answer and you can stop participating at any time.
Your Benefits: You may gain knowledge of the HINTS program that will aid you in your future research. There are no other direct benefits to you from participating in this study.
Benefits for Others:
The study results may help RTI improve its evaluation of the HINTS
Program by identifying ways to improve the protocol guides to
accurately tap users’ insight.
You will not receive compensation for participation in this interview.
Many precautions have been taken to protect your information. Your identifiable information, the audio recording and notes from the interview will be kept by the evaluation contractor, RTI, under lock and key. Identifiable information such as names and phone numbers will be kept separate from the interview notes and will not be included in a report or in subsequent publications or presentations. The findings from the interviews will be reported in summary form so that the participants cannot be identified.
Each interview will be audio-taped using cassette recorders or digital recorders. RTI will retain a copy of the audio files and/or cassettes and destroy them within a year of the project’s end. All tapes will be stored in a locked cabinet at RTI. Digital files will be kept on password-protected laptop computers and a share drive to which only RTI team members have access.
The Institutional Review Board (IRB) at RTI International has reviewed this research. An IRB is a group of people who are responsible for assuring that the rights of participants in research are protected. The IRB may review the records of your participation in this research to assure that proper procedures were followed.
We will not contact you in the future.
Your Rights
Your decision to take part in this research study is completely voluntary. You can refuse any part of the study and you can stop participating at any time. You can refuse to answer any question. If you decide to participate and later change your mind, you will not be contacted again or asked for further information.
Your Questions
If you have any questions about the study, you may call Linda Squiers at 301-570-8088or Marjorie Margolis at 1-800-334-8571 (extension 2-7184). If you have any questions about your rights as a study participant, you may call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number).
YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP.
Your signature below indicates that you have been read the information provided above, have received answers to your questions, and have freely decided to participate in this research. By agreeing to participate in this research, you are not giving up any of your legal rights.
___________________________________ _ ______________
Signature of Participant Date
____________________________________ __
Printed Name of Participant
| File Type | application/msword |
| File Modified | 2009-11-25 |
| File Created | 2009-11-25 |