Navigation Model Test for the Department of Labor's Employee Benefits Security Administration Website Redesign Effort

DOL Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Consent form

Navigation Model Test for the Department of Labor's Employee Benefits Security Administration Website Redesign Effort

OMB: 1225-0088

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I freely and voluntarily consent to participate in this research study.


I understand that my participation is completely voluntary and that I may withdraw my consent and discontinue my participation at any time without penalty or prejudice. I understand that I will be paid only if I complete both approximately 20-minute sessions on two separate days and that I make a reasonable effort to complete the activities thoughtfully.


I understand that my answers and opinions about finding information on a website will be collected during this study. I authorize the findings from this evaluation to be released to the research and development team of this site with the provision that my name will not be associated with any of the results.


I have been given the right to ask questions concerning the procedures to be employed during this study and to have these procedures explained to my satisfaction.


If you have logistical questions (e.g., participating in the study or technical issues during the study), please contact:


UserWorks, Inc.

phone: 301-431-0500 or 1-888-558-7872

email: [email protected]


If you have further questions about the study, please contact:

Stephanie Schreibman

Rock Creek Strategic Marketing

2 Wisconsin Circle, Suite 1000

Chevy Chase, MD 20815

email: [email protected]

phone: 301-657-0800


Paperwork Reduction Act.  This survey has been approved under Office of Management and Budget (OMB) control number 1225-0088 (exp. 6/30/14).  The Paperwork Reduction Act of 1995 provides that no person is required to respond to a Federal collection of information unless it displays a valid OMB control number.  Your response is voluntary and response time is expected to average 20 minutes per response, including 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 the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of the Chief Information Officer, Attention: Information Management Program, 200 Constitution Avenue, N.W., Room N-1301, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1225-0088.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSmyth, Michel - OASAM OCIO
File Modified0000-00-00
File Created2021-02-01

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