Census Bureau Study Consent Form The U.S. Census Bureau has asked us to help them improve the methods used to collect information about the U.S. population. We are doing this by testing how well some of their survey questions work. We will be reading you a series of questions about your household’s sources of income. We will also ask about your reactions to these questions, how you interpret key words in the questions, and to tell us why you chose one answer over other possible answers. Your participation today may help the Census Bureau perform its job better by collecting more accurate data.
The information you provide us 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 1 hour of your time. You will be paid $40 cash after the interview.
With your permission, we would like to audio-record the interview. It may also be observed by researchers from the Census Bureau. Recordings allow us to carefully review the discussion and draw the proper conclusions. The recording will be destroyed by March, 2012.
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.
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. I have read and understand the statements above. I consent to participate in this study.
Participant's signature Date
Participant's signature Interviewer’s signature
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| File Type | application/msword |
| Author | demai001 |
| Last Modified By | demai001 |
| File Modified | 2011-02-23 |
| File Created | 2011-02-23 |