Consumer Research for Nutrition Education and Promotion Activities

OMB Control # 0584-0524

Expiration Date: xx/xxxx

ATTACHMENT Q – CONFIDENTIALITY AGREEMENTS

This attachment includes four different confidentiality agreements to be used with research participants:

• Traditional in-person focus groups (parents, teachers, and school administrators)

• Web-based focus groups (child nutrition professionals)

• In-depth telephone interviews (internal and external partners)

• Benchmark and tracking surveys (child nutrition professionals and teachers)

FOR TRADITIONAL IN-PERSON FOCUS GROUPS

NOTE: This confidentiality agreement will be given to participants upon arrival at the focus group facility. The moderator will go through the agreement at the beginning of the discussion.

OMB Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required to complete this information collection is estimated to average 2 hours and 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 (0584-0524). Do not return the completed form to this address.

USDA Commodities

Opinion surveys, written notes by observers, and audiotape recordings created by a research study are called research records. The research records that will be collected and used for this study may include an opinion survey, written notes, and an audiotape made during your participation in the focus group discussion. However, your comments and survey responses will be shared only in the aggregate with those from the other participants within the written report. The focus group project director, an employee of an independent research company, Fleishman-Hillard Research, will maintain possession of the research records and will destroy them upon completion of the written research report.

Aggregated information/results from this study and portions of audio recordings (with no identification of individuals by name) may be presented in meetings or oral presentation to the USDA, Food and Nutrition Service (FNS). Your name, and any information that can be traced back to you, will not be included in any reports or meetings.

I understand that all information revealed during this interview or focus group (LOCATION/DATE/TIME) will be held strictly confidential by the research team collecting this information. I understand that my name will not be used in any meetings or reports regarding the focus group discussions.

Signature of Participant Date

Name of Participant (please print)

FOR WEB-BASED FOCUS GROUPS

NOTE: This confidentiality agreement will appear on the computer screen before the start of the discussion. After reading the agreement, participants will click on either AGREE or DISAGREE to indicate their understanding of this agreement. The moderator will also go through the agreement.

OMB Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required to complete this information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 (0584-0524). Do not return the completed form to this address.

USDA Commodities

Opinion surveys, written notes by observers, and audiotape recordings created by a research study are called research records. The research records that will be collected and used for this study may include an opinion survey, written notes, and an audiotape made during your participation in the focus group discussion. However, your comments and survey responses will be shared only in the aggregate with those from the other participants within the written report. The focus group project director, an employee of an independent research company, Fleishman-Hillard Research, will maintain possession of the research records and will destroy them upon completion of the written research report.

Aggregated information/results from this study and portions of audio recordings (with no identification of individuals by name) may be presented in meetings or oral presentation to the USDA, Food and Nutrition Service (FNS). Your name, and any information that can be traced back to you, will not be included in any reports or meetings.

I understand that all information revealed during this interview or focus group (DATE/TIME) will be held strictly confidential by the research team collecting this information. I understand that my name will not be used in any meetings or reports regarding the focus group discussions.

AGREE

DISAGREE

FOR IN-DEPTH TELEPHONE SCRIPTS

NOTE: This confidentiality agreement will be read to interview participants at the beginning of the interview and participants will be asked to provide verbal consent. The agreement will also be sent to scheduled participants (either by e-mail or regular mail) prior to the actual interview.

OMB Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required to complete this information collection is estimated to average 40 to 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 (0584-0524).

USDA Commodities

Opinion surveys, written notes by observers, and audiotape recordings created by a research study are called research records. The research records that will be collected and used for this study may include an opinion survey, written notes, and an audiotape made during your participation in the interview. However, your comments and survey responses will be shared only in the aggregate with those from the other participants within the written report. The focus group project director, an employee of an independent research company, Fleishman-Hillard Research, will maintain possession of the research records and will destroy them upon completion of the written research report.

Aggregated information/results from this study and portions of audio recordings (with no identification of individuals by name) may be presented in meetings or oral presentation to the USDA, Food and Nutrition Service (FNS). Your name, and any information that can be traced back to you, will not be included in any reports or meetings.

Do you understand that all information revealed during this interview (DATE/TIME) will be held strictly confidential by the research team collecting this information, and that your name will not be used in any meetings or reports regarding the focus group discussions?

YES

NO

Do you consent to participate in this study?

AGREE

DISAGREE

FOR BENCHMARK AND TRACKING SURVEYS

NOTE: This confidentiality agreement will appear on the computer screen before the start of the survey. After reading the agreement, participants will click on either AGREE or DISAGREE to indicate their understanding of this agreement. If a participant selects DISAGREE, they will not be able to take the survey.

OMB Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 (0584-0524). Do not return the completed form to this address.

USDA Commodities

Opinion surveys created by a research study are called research records. The research records that will be collected and used for this study includes an opinion survey. However, your comments and survey responses will be shared only in the aggregate with those from the other participants within the written report. The focus group project director, an employee of an independent research company, Fleishman-Hillard Research, will maintain possession of the research records and will destroy them upon completion of the written research report.

Aggregated information/results from this study may be presented in meetings or oral presentation to the USDA, Food and Nutrition Service (FNS). Your name, and any information that can be traced back to you, will not be included in any reports or meetings.

I understand that all information revealed during this survey will be held strictly confidential by the research team collecting this information. I understand that my name will not be used in any meetings or reports regarding the focus group discussions.

AGREE

DISAGREE

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