NCFO Questionnaire (draft) including ICR statement

Form Number RITA-NCFO-003

U.S. Department of Transportation		1200 New Jersey Avenue, S.E. Washington, D.C. 20590
Research and Innovative Technology Administration

2010 National Census of Ferry Operators (NCFO)

Operator Interview Consent Form

Thank you for participating in this interview. Your feedback will help the Bureau of Transportation Statistics (BTS) improve the 2010 National Ferry Operators Census Form. The purpose of this interview is to learn how different ferry operators would go about filling out various parts of the census form. Your participation in this interview is voluntary and you may discontinue your participation at anytime. The interview will only take about 60 minutes to complete.

The information obtained from this interview will be used to improve the census forms. While the information may be published in scientific journals or presented at scientific meetings, at no time will you or the name of your operation be associated with any information you provide. Your name and the name of your ferry operation will only be known to the individuals within BTS who are working on this project.

In an effort to keep track of the feedback you provide during this interview, we would like to record the interview for later analysis. If permission to record the interview is granted audio files and other information from the interview will be kept in a locked filing cabinet until the project is over and destroyed upon completion of the project.

I have read the information above. I freely choose to participate in the NCFO interview.

	I agree to have my interview audio taped.
	I do not wish to have my interview audio taped.

Participant’s Name		Signature		Date