Invitation

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This collection of information is voluntary and will be used to gauge potential travel-behavior response to far-reaching improvements in the pedestrian, cycling, and transit environments of neighborhoods. Public reporting burden is estimated to average 1 hour and 45 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. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 2125-XXXX (state OMB #). Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Highway Administration, 1200 New Jersey Avenue, SE, Washington, DC 20590.

University of Illinois at Chicago

Consent Information for Participation in Research

Transit Behavior Study

You are being asked to be a subject in a research study about how you travel from place to place. The study is being directed by Moira Zellner, Ph.D, and colleagues, along with the Survey Research Laboratory at the University of Illinois at Chicago. You have been asked to participate in this research because of where your home is located within the Chicagoland area. We ask that you read this form and contact us with any questions you may have before agreeing to be in the study. Your participation in this research is completely voluntary.

Why is this research being done?

The purpose of the study is to learn how people travel and how those choices are affected by opportunities in their neighborhood and beyond.

What procedures are involved?

If you are selected to participate in this study, you will complete the enclosed travel diary on the specified date. After you complete the diary, an interviewer will call you and ask you questions about your travel and what you recorded in your diary. This interview is expected to last approximately X minutes.

What are the potential risks and discomforts?

This study does not involve any risk or discomfort for participants, since the questions we ask are not of a personal or sensitive nature.

Are there benefits to taking part in the study?

Participating in the study is not expected to be of direct benefit to you. However, the information you supply will help researchers make recommendations about improvements to transportation systems in Chicagoland and beyond.

What about privacy and confidentiality?

With the exceptions noted below, the only people who will know that you are a research subject are Survey Research Laboratory staff who will separate your interview responses (with no identifying names) from your contact information. Your contact information will be kept in a locked cabinet at the Survey Research Laboratory. It will only be used for the purposes of contacting you for the telephone interview. When the results of the research are published or discussed in conferences, no information will be included that would reveal your identity as your responses will be combined with the responses of other research subjects in the study. All contact information will be destroyed upon completion of this study.

Will I be reimbursed for my participation in this study?

Upon completion of the study, you will receive a $50 check as expression of appreciation for your time and effort contributing to this study

Can I withdraw from the study?

You can choose whether to be in this survey component of the study or not. If you continue to volunteer to be in the study, you may withdraw at any time without consequences of any kind. You may also refuse to answer any questions you don’t want to answer and still remain in the study.

Who should I contact if I have questions?

The researcher conducting this study is Moira. If you have any questions about the study, you may contact her at any time by phone at (312) 996-2149 or by e-mail at [email protected].

What are my rights as a research subject?

If you have any questions about your rights as a research subject, you may call the Office for Protection of Research Subjects at 312-996-1711.

Remember: Your participation in this research is voluntary. Your decision whether or not to participate will not affect any current or future relations you may have with the University. If you decide to participate, you are free to withdraw at any time without affecting that relationship. Please retain this document for your information and to keep for your records.

V#1, 11/24/10 W3 Mail Survey Consent Information Sheet Page 2 of 2