Attach1_Consent_CIP

Attach1_Consent_CIP.doc

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

Attach1_Consent_CIP

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Informed Consent Form



NCI Cancer Imaging Program (CIP)



Informed Consent to Participate in website Usability Testing

You are being asked to participate in usability testing of the National Cancer Institute’s Cancer Imaging Program (CIP) website. The National Cancer Institute is part of the National Institutes of Health, a federal agency within the U.S. Department of Health and Human Services. The purpose of this usability testing is to help ensure that the CIP website is achieves its objectives of providing information about CIP programs, research funding opportunities, etc. for medical researchers, medical professionals, patients and the general public.

We are with NOVA Research Company (NOVA). NOVA is an independent evaluator contracted by the National Cancer Institute to assess the CIP Web site.

A usability test is a test of the Web site, not the user! It is intended to show whether the site is easy for people to use and fulfilling its purpose. We will ask you to carry out basic tasks and activities on the CIP Web site such as clicking on certain links. The information collected during the test can help make the CIP site better for everyone who uses it.

The usability testing will last about 1 hour. A trained person will lead it. Please ask the person who is leading the usability testing any questions you might have before you agree to participate.

If you agree, we will record your usability test. NOVA staff will use transcripts of this recording to remember what you said. We will keep these electronic recordings in a secure location. The National Cancer Institute will retain ownership of all data collected. When these data are submitted to the CIP, no identifying information will be included.

NOVA will use transcripts to summarize your experiences and opinions. The transcripts and reports will NOT include your name or other identifying information. All data in reports will be in aggregate form, and no links to individuals will be kept.

We will keep what you say private unless we are required by law to disclose it. We will take extra steps to protect your privacy. You will be asked not to discuss any information shared during the test with persons who did not participate in the testing.

If you do not like or feel uncomfortable with any questions, you can choose not to answer them. You can stop participating in the test at any time. Participating in the usability test or interview does not cost you anything.

Your participation is voluntary. You are free to choose not to participate in the usability test. Choosing not to participate will in no way affect your relationship with the National Cancer Institute or the CIP.

Should you qualify, we are offering a $40 Visa gift card for your participation. (Note: If you are employed by the U.S. Federal government, you are not eligible to receive the incentive.)

If you have any questions about this usability test, please contact one of the individuals below.

Dan Eckstein

Kathy Sedgwick


Address: NOVA Research Company

4600 East-West Highway, Suite 700

Bethesda, Maryland 20814

Telephone: 301-986-1891

To participate, please read and sign the form below. We will give you a copy of this signed form at your request.

SIGNATURES

By signing, you indicate that you have read this form and that you understand what you are consenting to and your rights as a research participant.

I agree to take part in a usability test of the CIP website.

I consent to be audio-recorded during this usability testing.

____Yes ____No (but I still want to be part of the usability testing)


______________________ ___________________________ _____________

Participant’s Printed Name Participant’s Signature Date

Thank you for your time!


NOVA Research Company, November 20, 2012 Page 2 of 2



File Typeapplication/msword
File TitleMini Supporting Statement
Authoraed-user
Last Modified ByVivian Horovitch-Kelley
File Modified2012-12-03
File Created2012-11-20

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