Various Demographic & Decennial Areas Pretesting Activities

Participant Consent Form

The U.S. Census Bureau has asked Westat to gather perceptions of commonly used questions used in social surveys to determine how people within a household are related to one another and their marital status. The discussion you have been asked to take part in may be helpful in improving these questions so that information collected about relationship and marital status is more accurate.

The information you provide in the interview will be treated as confidential. You will not be identified by name in any of our reports. Your information will be combined with information from other respondents and presented in summary form.

We will need about 2 hours of your time. You will be paid $75 cash after the discussion.

The group’s discussion will be both audio-recorded and video-recorded. It will also be observed by other researchers on the project. Recordings allow us to carefully review the discussion and draw the proper conclusions.

When not in use, all information collected for this project is being stored in locked cabinets or on secure project drives and is inaccessible to persons not working on this project. The information you provided to us in your screening interview (to determine your eligibility for the study) will be destroyed by May 31^st, 2010. The recordings will be destroyed by March, 2011.

Your participation is voluntary and you have the right to leave at any time. You may also decline to answer any questions that we ask.

The researcher will be happy to answer any questions you have about the study.

If you agree to participate, please sign below.

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I have read and understand the statements above. I consent to participate in this study.

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Participant's signature Date

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Participant's printed name

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.