SNAP Households

APPENDIX J

IN-DEPTH INTERVIEW CONSENT FORM

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DRAFT Consent Form

Your Participation in this study is voluntary.

Introduction/Purpose:

You are being asked to participate in a research study about the Supplemental Nutrition and Assistance Program, or SNAP, which is also known as food stamps. The purpose of this study is to learn more about families and their food needs.

In this interview, we will ask questions about your participation in the SNAP program, how you make decisions about food, and your general financial well-being. This interview will take approximately 90 minutes to complete.

The interview will be conducted at the time and place of your choosing. With your permission, the interview will be recorded on a digital recorder. The purpose of recording the interview is to be able to write up notes later. No one outside the study team will listen to the recording.

Benefits:

Your participation in this study may facilitate making the SNAP program more accessible and helpful for families like yours. You will also receive a $XX store gift card as a token of appreciation for participating in this discussion.

Privacy:

You participation in this interview will not affect any government assistance you are receiving now or in the future. All answers you give will be private and your name will not be associated with the results. You may also choose to not answer any question you do not want to answer. All audio recordings will also be destroyed when no longer needed.

Contact:

If you have questions or concerns about this research study, please contact: NAME AND TELEPHONE NUMBER

Agreement:

I have read this form and the research study has been explained to me. I agree to participate in the research study described above.

Signature: ________________________________ Date: _________________

Name (print): _____________________________