Congnitive Lab Consent Form

Consent Form

Purpose: We are inviting you to participate in a research activity. The research involves individuals completing a survey and then answering questions about the experience of completing it. The feedback will help us to develop recommendations for improving the survey.

Sponsorship: Westat is conducting this project on behalf of, and funded by, the Bureau of Justice Statistics (BJS).

What is involved: We will be asking you to complete a paper survey and then answer questions about it. Your participation in this research project is voluntary, and you have the right to stop at any time or to refuse to answer any question. The session will take approximately 60-90 minutes.

Confidentiality: We would like to record the interview. Sometimes it is helpful to review a portion of a recording as we make recommendations for improving the survey. If the recording is reviewed later, it will only be by a few Westat staff and possibly the client.

You will never be identified by name. The things you say may be put in a written summary of this discussion, but there will be no way to identify who said what, and your name will not be used anywhere.

Risks: The only cost to you is the time and effort to answer questions. You may skip any question that you do not want to answer, both in the questionnaire and in the discussion afterwards. The information you provide will be treated as confidential. The recordings will be destroyed within 3 months of the end of the study.

Benefits: There are no direct benefits to you for participating in this study. However, you will be helping with an important research project.

Questions: If you have questions about the project, you may call the Task Manager, Pat Dean Brick, at 800-937-8281, Ext. 4196. For questions about your rights and welfare as human subjects in this study, you may call the Institutional Review Board at Westat at 301-610-8828.

You will be paid $50 cash for completing the session.

If you agree to participate, please sign below.

I have read and understand the statements above. I consent to participate in this session.

Participant’s signature Date