Consent

Survey of Crime Victimization
CONSENT TO PARTICIPATE IN RESEARCH

Purpose. The Survey of Crime Victimization is being conducted by the Bureau of Justice
Statistics (BJS) of the Department of Justice, and NORC, a research organization at the
University of Chicago. The purpose of the study is to evaluate the feasibility of a twelve-month
reference period when collecting data instead of a six-month reference period.
Procedures. For the cognitive interviews, we will collect information from approximately 100
individuals. If you agree to participate, I will ask you some background information, which may
include noting important events in your life in an event history calendar. This will be followed by
questions about crime and your experience with crime victimization. I also will ask a series of
debriefing questions that will help us revise the current questionnaire. Your responses will be
completely confidential. The survey should take between 45-60 minutes.
Confidentiality. All information that you provide will be kept confidential. Your name will not
be attached to the answers that you provide. All responses are held to strict federal laws regarding
human subject protections (28 CFR Part 46), and confidentiality (28 CFR Part 22). Any reports
published for this study will exclude any data that could lead to your identification.
Possible Risks and Discomforts. Some questions in this study are of a personal nature and you
may find them embarrassing or distressing. If you are upset or uncomfortable you may skip any
question, or you may stop the interview at any time.
Voluntary Participation/ Compensation. Your participation is completely voluntary. A
decision to not participate will not be held against you. If you agree to participate, you will
receive $40 as compensation for your participation in the study.
Further Questions. If you have any questions about the project, you may call Project Director
Jim Carr at 312-759-5088. . If you have questions about your rights as a project participant, you
may call Kathleen Parks, administrator of NORC’s Institutional Review Board, toll-free at 866309-0542.
If you have questions and would like to contact BJS directly, please contact Michael Rand, Chief,
Victimization Statistics Unit at 1-202-616-3494.

With your permission, we would like to record this interview for quality assurance purposes. You
will not be penalized for refusing, and will still receive the $40 compensation.
[READ ONLY IF OBSERVER PRESENT: A member of the research team would like to observe
the interview. Do we have your permission to allow this individual observe this interview?]