Various Demographic Pretesting Activities

ACS Supporting Materials for Group Quarters

Participant Informed Consent

Cognitive Interview

You are invited to participate voluntarily in this interview, which is being conducted by RTI International (RTI), a not-for-profit research firm, and Research Support Services (RSS), a contract research firm, for the U.S. Census Bureau. The purpose of this interview is to help the Census Bureau review the materials used for the American Community Survey (ACS) Group Quarters data collection to ensure that the documents are well understood.

The interview and discussion will take approximately 60 to 75 minutes. There are no right or wrong answers to the questions we ask—we just want to ask your opinion about a letter and brochure that have been developed. We will first ask you to read the survey materials silently to yourself, and then we will ask you to give us your general impression and comprehension of the text. Following this, you will be asked to read aloud the specified text and you will be asked how you understand specific terms and phrases that you have just read. Then, we will ask your opinions about suggested recommendations for changes. Finally, we will ask about your thoughts and feelings toward the materials overall. You can help us by describing anything you find confusing or difficult to understand in the materials. In appreciation for your participation in this project, you will receive $40.00.

Your participation in this study is voluntary, and you may stop at any time. Even if you choose not to participate, you will not lose any benefits or services that you may be receiving from any governmental agency. Also, you may choose not to answer any question. You will be paid $40 in appreciation for your time, even if you decide to stop the interview. Your participation will be kept confidential, and the information you give us will be combined with the responses of others in a summary report that does not identify you or your facility individually. We will not share any personal information you give us during the interview with any person outside the project staff at RTI, RSS, and the Census Bureau. There are no expected risks to participating in this study. Your identifying information is protected by Title 13 of the United States Code (Sections 141, 193, 221, and 223).

If you have any questions about the study you may telephone the lead researcher, Tim Flanigan, at 1-800-334-8571, ext. 27743. If you have any questions about your rights as a research participant in this study, you may contact the Office of Research Protection at RTI International at 1-866-214-2043, a toll-free number.

______________________________________________________________________________

The above document describing this research study has been explained to me. I agree to participate.

Signature of participant______________________________________________ Date ___/___/___

I certify that the nature and purpose of this research have been explained to the above individual.

Signature of Person Who Obtained Consent_______________________________ Date ___/___/___

Turn to other side

Audio-taping the interview:

In order to make best use of our findings, we also request that you allow the interview to be audio-taped, through the use of a tape recorder that will be on the table. The audio-tape will only be heard by people who are working on this project from RTI, RSS, and the Census Bureau. The only purpose of audio-taping is to allow us to review the interview as we document our findings. If you would rather that your interview not be audio-taped, or if any time during the interview you decide that you would like the audio-taping to be stopped, please tell the interviewer and we will stop taping.

______________________________________________________________________________

I agree to allow the interview to be audio-taped and to be listened to by others who are working on this project:

Signature of participant ____________________________________ Date _____/_____/_____

Disposition: Participant signs original. Interviewer submits to RTI/RSS. Participant keeps another original for records.