Consent forms for demographic collections

Demographic Pretesting With Adults

Consent Form

Name of Survey—e.g., National Crime

Victimization Survey

Identity Theft Supplement

Each year the Census Bureau conducts many different surveys. The Census Bureau routinely tests the questions used on these surveys in order to produce the best information possible.

You have volunteered to take part in a study to improve the questions that will be used in the [name of survey—e.g., National Crime Victimization Survey Identity Theft Supplement]. In order to have a complete record of your comments, your interview session will be audiotaped. 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 participation is voluntary and your answers will remain strictly confidential.

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 Census Bureau questionnaire design study, and I give permission for my tapes to be used for the purposes stated above.

____________ ____________________________ _____________________________ ____________________________________

Researcher's Signature Participant's Signature

____________________________ ____________________________________

Researcher’s Name Participant’s Name

_________________________ ________________________________ Date Date

Demographic Pretesting With Minors

Consent Form

Name of Survey—e.g., National Crime

Victimization Survey

Internet Predation Questions

Each year the Census Bureau conducts many different surveys. The Census Bureau routinely tests the questions used on these surveys in order to produce the best information possible.

______________________[CHILD’S NAME] has my permission to take part in to take part in a study to improve the questions that will be used in the [name of survey—e.g., National Crime Victimization Survey Internet Predation Questions]. In order to have a complete record of your comments, your interview session will be audiotaped. 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 participation is voluntary and your answers will remain strictly confidential.

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

_________________________________ ___________________________

Parent's Signature Researcher's Signature

__________________________________ __________________________

Printed Name Printed Name Printed Name Printed Name

________________________________________________________________

Date Date