Application Survey

Script for Introducing the Research Study
[The Financial Clinic/SFLUM] is working with the Urban Institute in Washington, DC and
the Consumer Financial Protection Bureau, a federal agency, on a study on the effects of
financial coaching programs on our customers. Your participation is voluntary but is muchappreciated. The report that results from this study will help researchers and policymakers
understand how these programs can better serve individuals like you and communities like yours,
so we hope that you will be willing to participate.
The goal of this study is to understand how financial coaching programs affect financial
outcomes, so we are going to be looking at things such as: what your household income and
expenses look like, what kinds of bank accounts you have, and how you feel about your finances
in general.
Because we have a limited number of financial coaches, we will only be able to provide
services to half of the study participants right now, and the other half will be able to receive
services once the study period has ended in about a year. To make it fair, we will randomly
decide who receives treatment now, and who will receive it later. In other words, you have about
an equal chance of getting services now or getting them later.
Those receiving services now will meet with the [The Financial Clinic/SFLUM]’s financial
coaches and work together to build your savings, improve banking and credit files, reduce debt
and discuss taxes. We will also be pulling credit reports of study participants to help us better
understand the financial situation of individuals who are receiving services at [The Financial
Clinic/SFLUM].
Everyone who is in the study, whether you get services now or not, will be asked to complete
our application form today, and a more in-depth outcomes survey over the phone at the end of
2013. We cannot stress how important this follow-up survey is to the study. We will also be
providing a $30 dollar gift card to you after you complete the outcomes survey in 2014.
We want to assure you that the information that we collect in the application form, from the
credit report, and in the later outcomes survey will be kept private. This information will be
combined with information from all other study participants and will not be reported or shared in
a way that would allow anyone to link what you tell us with who you are. We will not publish
your name or other personal identifying information in anything we write or talk about. We also
will not share information that identifies you, including your name or information from your
credit report, with anyone outside of the research team, including the Consumer Financial
Protection Bureau. All of your answers will be stored in databases with secured password
protection and accessed only by research staff who are committed to ensuring your privacy, and
who have signed data privacy pledges.
An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless the collection of information displays a valid control number

assigned by the Office of Management and Budget (OMB). The OMB control number for this
collection is 3170–XXXX. The collection expires on XX/XX/XXXX. Also, a federal law called
the Privacy Act directs how the federal government treats personally identifiable information
contained in your answers to these questions. To understand how and when your personally
identifiable information may be shared, you can read the Privacy Act Statement on the CFPB’s
website at www.consumerfinance.gov and search for CFPB.021 Consumer Education and
Engagement Records. Additionally, the CFPB will treat the information received from you
consistent with its privacy regulations at 12 C.F.R. Part 1070, et seq. We anticipate the
application form taking about 10 minutes of your time, and the follow-up survey taking about 40
minutes of your time.
We have an informed consent document that we would like to review with you and have you
sign to agree to participate in the research study. This document explains the study and your role
as a participant. This also gives you contact information if you have any questions about the
study, and we will make you a copy that you can keep for your own records.
[REVIEW CONSENT FORM, AND SIGN]
Do you have any questions before we begin?
An agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless the collection of information displays a valid control number assigned by
the Office of Management and Budget (OMB). The OMB control number for this collection is
3170–XXXX. The collection expires on XX/XX/XXXX.