Tenant Consent Form

Department of Housing and Urban Development

Quality Control for Rental Assistance Subsidy Determinations Study

Household Interview Consent Form

Name of Tenant: _________________________________ C/P/C: _____/______/_____

Purpose. You have been selected to participate in a research study being conducted by the United States Department of Housing and Urban Development (HUD). The purpose of this study is to learn more about the types of errors that occur when determining tenant eligibility and monthly rent in HUD programs so that improvements can be made. We will be interviewing 2,400 randomly selected households from all over the United States.

Study Procedures. We have already contacted the staff at the local housing office. They provided your name and allowed us to review the file they created when they determined the amount of rent you pay. Today, I plan to interview you. The interview will take from 40 to 60 minutes. This interview will include questions about who lives in your home with you, income received by your household, and any assets or other expenses you may have. Your responses to the questions will be entered into a laptop computer and transmitted to the study headquarters where the information will be processed.

Risks and Benefits. Participation in this study will not result in any direct benefit to you. The study findings will be used to make HUD program changes that will lead to fewer errors when determining eligibility for housing assistance and calculating the amount of tenant rent. You need to know that if you do not provide complete and accurate information you may lose your housing assistance. Also, you may find that some of the questions are of a personal nature and you may feel uncomfortable answering those questions.

Confidentiality. All information collected during this study will be kept confidential by the individual field interviewers who conduct the interviews. The information is transferred to secure computer systems at the study headquarters. The information will not be shared directly with staff at your local housing project. However, individual level information is provided to HUD headquarters in Washington, DC. This information is matched with centralized national databases such as Social Security files that contain information on the income received by individuals throughout the United States. The confidential information collected during this study is protected under the Privacy Act (5 U.S.C. 522a). Disclosure of any confidential information may be subject to criminal sanctions imposed by 18 U.S.C 641.

Participant Rights. Persons who receive housing assistance from HUD programs are required to participate in this study. You agreed to do so when you signed the rental assistance forms. You need to know that HUD may stop your housing assistance if you choose to not participate in this study or you do not respond to the questions asked during the interview. If you have questions about this study, you can talk with the study director using the toll-free number, 877-392-9776.

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Field Interviewer Certification. By signing this document, you are certifying that you read this agreement to the respondent and he/she has

□ agreed □ not agreed

to participate in the FY2010 Quality Control for Rental Assistance Subsidy Determinations Study.

Field Interviewer Name: _____________________

Field Interviewer Signature: ____________________________ Date: ______________

Tenant Consent FY2010 H-TC November 2010