Attachment W(g) interview 1 consent form

U.S. Consumer Expenditure Records Study
Informed Consent Form – Interview 1

Description and Purpose of the Consumer Expenditure Records Study: The U.S.
Consumer Expenditure Quarterly Interview (CEQ) is an ongoing monthly survey
conducted by the U.S. Census Bureau for the U.S. Bureau of Labor Statistics (BLS). The
survey provides current and continuous information on the buying habits of American
consumers. The Census Bureau and BLS are conducting research to increase the quality
of their surveys. The results of this study will be used to improve the way the CEQ is
conducted. This interview is being conducted by RTI International, a research
organization located in Research Triangle Park, NC. You are one of up to 100 people
asked to participate in this study.
Interview Details: This study asks about your household expenses in a number of
categories such as utilities, appliances, household furnishings, clothing, health insurance,
subscriptions, etc. This study consists of two interviews that will be conducted on two
different days. During this research you may be audio-taped or the interview may be
observed by Census Bureau or BLS employees. The purpose of audio-taping and
observation is to provide the Census Bureau and BLS with feedback on the interview
process so it can be improved, if necessary. Another purpose of audio-taping is to verify
that the information from the interview is entered into the computer correctly. All audiotapes will be kept confidential and will be destroyed at the completion of the study. If you
do not wish to be taped or observed, you still may participate in this research.
Length of Interview: We anticipate the interview will take about 90 minutes to
complete on average. However, this is only an estimate, as it will vary depending on a
household’s purchases in the last three months.
Participation Requirements/Compensation: Participation in both interviews is
voluntary, and there are no penalties for refusing to answer any questions. If you do agree
to participate, and complete the first interview, you will receive $40 as compensation for
your time. At the end of the interview, the interviewer will schedule an appointment for
the second interview to occur within one week.
Confidentiality: The Census Bureau, BLS, their employees, agents, and partner
statistical agencies, will use the information you provide for statistical purposes only and
will hold the information in confidence to the full extent permitted by law. In accordance
with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title
5 of Public Law 107-347) and other applicable Federal laws, your responses will not be
disclosed in identifiable form without your informed consent. In accordance with the
Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified that this study
is sponsored by the U.S. Department of Labor, Bureau of Labor Statistics (BLS), under
authority of 29 U.S.C. 2. Your voluntary participation is important to the success of this
study and will enable BLS to better understand the accuracy of information BLS collects.

Possible Risks and Discomforts: Some questions in this first interview are of a personal nature
and you may find them uncomfortable. If you are upset or uncomfortable you may skip any
question, or you may stop the interview at any time.
Possible Benefits: There are no benefits to participating in this study, but your answers will help
the Census Bureau and BLS better understand the buying habits of Americans.
Further Questions: If you have any questions about the Consumer Expenditure Records Study,
please call the Project Manager, Ms. Emily Geisen at 919-541-6566. If you have questions about
your rights as a study participant, call RTI’s Office of Research Protection at 1-866-214-2043 (a
toll-free number).

Persons are not required to respond to the collection of information unless it displays a
currently valid OMB control number. OMB control number is 1220-0050 and expires
03/31/2013.
-----------------------------------------------------------------------------------------------------------I have read and understand the statements above. I consent to participate in this first
interview.
Audio-taped: Check one.
I agree to be audio-taped in the second interview.
I do not agree to be audio-taped in the second interview.
Observed: Check one.
I agree to be observed in the second interview.
I do not agree to be observed in the second interview.

___________________________________
Participant's signature
___________________________________
Participant's printed name
___________________________________
Researcher's signature
OMB Control Number: 1220-0050
Expiration Date: 03/31/2013

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Date