Follow up survey consent form

Appendix A.

Family Options Study

Follow-up Survey Consent Form

The Department of Housing and Urban Development (HUD) wants to continue to be in contact with families who agreed to participate in the Family Options Study to find out how the families are doing. The Family Options Study was designed to help HUD understand how different services and interventions helped families who were experiencing homelessness. You and your family became part of this research study between September 2010 and January 2012. You may remember meeting with an interviewer who explained the study, completing a survey, and going through a lottery to determine what type of assistance you would receive. You may also recall receiving a $35 money order after completing the survey.

When you enrolled, you signed a participation agreement. This agreement explained that when you joined the program, you agreed to allow the researchers conducting the study to collect information about you from programs that you participate in. The agreement also explained that researchers would contact study participants every six months or so to ask about your experiences.

At this time, we are asking you to complete a survey that will take approximately one hour. This survey will ask about your current housing, your family composition, your health, education, and income. The survey will also ask about any services you received since you enrolled in the Family Options Study about 18 months ago. You will receive $50 for your time. Your participating in this survey is voluntary. You can also choose not to answer any question.

HUD is very interested in learning as much as possible from the experiences of all families that enrolled in the Family Options Study. At this time, we would also like your permission to allow researchers to continue to contact you periodically over the next couple of years. Your continued participation means that you agree to allow researchers to contact you again in the future to ask questions about your experiences. Agreeing to participate also means that you give the program staff and researchers permission to get other types of information about you. Researchers may get information from other government programs as part of research studies that evaluate the housing and services interventions that are part of this study. That means that everyone in the study gives permission to the researchers to collect information about you and your family such as:

• The dates of your participation in shelter, housing, or services programs

• Information about earnings from jobs from unemployment insurance wage records or other earnings data

• Information about receipt of public assistance or disability benefits

• Child welfare records

• Information about new addresses from any of these sources

Who will see the information I provide?

All information you provide is confidential. Your information will be protected to the extent allowed under the law as part of the Privacy Act.¹ This means, for example, that we may need to notify someone if keeping the information confidential could put you or others at risk of harm. Only the interviewer and a small number of staff authorized to work on research evaluations of housing and services interventions that are part of this study will see your survey responses. Any information that the researchers collect about you from other programs will also be kept confidential to the extent allowed by law. Your name will never be used in any report. Reports for this study will only show summaries, no names or individual identifying information will ever be used in any research report.

Are there any risks if I continue to participate in this study?

The risks to you of continuing to participate in this study are minimal. However, there are some potential risks. Risks could include the possibility that:

• You might be uncomfortable or even upset answering some of the questions on the interviews. If you feel that way, you can choose not to answer any question on any of the surveys. You can also stop the interview at any time.

• There is some risk that your information could be released to people other than the researchers doing this study. The study has strict procedures in place to protect the information you provide and to prevent this from happening. However, if that were to happen, we would contact you to let you know that this occurred.

• There is some risk that people other than the researchers doing this study or the service providers to which some treatment group members will be referred could find out that you are a participant in the study. The study has strict procedures in place to prevent this from happening. However, if that were to happen, we would contact you to let you know that this occurred.

Questions about participation

If you have questions regarding this study please contact the Abt Associates Inc. Project Director, Ms. Michelle Wood at (877) 903-0852 (toll-free). You may also contact Ms. Anne Fletcher at the U.S. Department of Housing and Urban Development at (202) 402-4347 (not a toll-free number).

If you have any questions about your rights as a participant in this study, you can call Ms. Teresa Doksum, the IRB Administrator at Abt Associates toll-free at (877) 520-6835.

Consent by Participant

By signing this participation agreement, I confirm that I have read and understand the information presented in it. The information in this form has also been explained to me. I have had the opportunity to ask questions. I understand that my participation is voluntary, and I can ask to be withdrawn from the study at any time. I understand that I will be given a signed copy of this consent form to keep. I voluntarily agree to take part in this study of programs for homeless families.

Participant’s Name – PLEASE PRINT

Participant’s Signature Date

Participant Study ID#__________________

1 Privacy Act Statement: HUD’s authoritative and principle purpose, conditions of uses, and impacts, if any, for not participating in the survey are referenced within the participant agreement.

Abt Associates Inc. Appendix A: Revised Participation Agreement (Informed Consent Form)