Attachment W(h) interview 2 consent form

U.S. Consumer Expenditure Records Study
Informed Consent Form – Interview 2
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. The 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: During this interview, information you provided in the first interview
will be compared with any receipts or records that you have gathered. The information
compared will include the price, item description, date, and other information available
on the receipt or record. No personal information, such as account numbers or credit card
numbers, will be recorded from your receipts and records, and no copies of receipts or
records will be taken away from your home.
During this second interview 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 audio-tapes 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 2 hours 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 this second interview is
voluntary, and there are no penalties for refusing to answer any questions. If you do agree
to participate, and complete the second interview, you will receive $60 as compensation
for your time.
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 second 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 second
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

___________________________
Date