Small Dollar Lending Rule Disclosure Testing (Payday)

INFORMED CONSENT FORM
You are being asked to participate in a research study. This form describes the purpose, procedures, benefits, risks
and precautions of the study. It also describes your right to withdraw from the study at any time. A member of the
study staff is available to read through this form with you and discuss all the information, if you wish.

Why is this study being done?

This study is being done to better gauge the usability and effectiveness of a variety of documents that borrowers may
receive throughout the process of taking out a payday loan or other similar loan. The study will ask participants to
answer questions about their impressions and understanding of the various notices shown.

What do I need to know about this study?

Adults 18 and older are asked to participate in these one-on-one interviews. Each interview will last 60 minutes. The
interview will be video recorded, but individuals’ names will not be used in any description of findings. In accordance
with the Paperwork Reduction Act of 1995, the questions asked as part of this study have been approved by the
Federal government’s Office of Management and Budget (OMB) under OMB control number 3170-0022. Without this
approval, we could not ask these questions.

What are the potential risks of being in the study?

There are minimal risks associated with this study. Participants will talk about their perceptions and comprehension
of a few sample notices provided to them. Participants do not have to answer any questions that they do not want to
answer.

Does being in this study provide any benefit?

The study will help to improve the clarity and design of notices that consumers taking out payday loans and other
similar loans receive. Participants in the study will receive $75 for their participation.

Will it cost me anything to be in this study?

There are no costs to participate in the study, other than possible transportation costs to and from the facility.

Do I have to be in this study?
Participation is voluntary.

Who will have access to this study and/or contact information?

Only the researchers working on this project will have access to the information provided in the study.

Who do I contact if I have questions about the study?

If you have questions or concerns about the study, you can contact
Kinsey Gimbel, Fors Marsh Group, [email protected], 571-858-3777.

I, _______________________________________, have read this form and agree to participate in this study.
Print Name
_________________________________________________________________________________________
Participant’s Signature
Date
_________________________________________________________________________________________
Researcher’s Signature
Date

1010 N. Glebe Road, Suite 510 | Arlington, Virginia 22201 | www.forsmarshgroup.com