Consent Language

Abt Associates, Inc.

Appendix L: Consent Language

Consent Language

Respondents will be asked for the household and process study data collections will be asked for consent verbally. This consent language is at the beginning of the instruments submitted in other appendices. It is also submitted as a separate appendix here.

Household Instrument

English Version

At the Beginning of the Interview:

Hello, my name is _________ and I’m calling on behalf of the U.S.D.A., Food and Nutrition Service. We are conducting a research study about the food choices of children and their families.

The interview will take approximately 25 minutes. It has questions about your child’s food choices as well as general questions about you and your household. Your answers will help the government make its child nutrition programs better for school-age children. As a way of saying thank you, we will give you a $10 gift card when we are finished.

Your participation in this interview is voluntary and you may stop at any time. Your benefits will not be affected if you choose not to participate. If you take part, you may refuse to answer any questions. If you take part, your answers won’t change any benefits you may receive from any agency.

All the information you give us will be kept confidential to the extent allowed by law. Your name will not be attached to any of your answers. Your information will be used only in combination with information from other households for research purposes.

Do you have any questions before I begin?

At the End of the Interview:

We would like your permission to let [Name Department] give us your records on how you used your Summer EBT card.  We are asking them for the period June through September of this year. We also would like to have the [Name Department] tell us whether you have participated in the SNAP or WIC program in the past year.

 

[For sites with passive consent] Finally, we would also like your permission to have the [name of school district] provide us with information from your child/children's National School Lunch application as well as some administrative information from your child's school records. This data will include items such as age, grade level and other administrative information. It will not include academic or disciplinary information.

 

Your records will only be used for this study.  They will be kept confidential to the extent provided by law. Any datasets resulting from this study will not identify you or your child. Releasing your records is completely voluntary, and you may refuse. Your decision won’t change any benefits you may get from any agency.  Would you be willing to release these records?

There is minimal risk to participating in this study. The main risk is a breach of confidentiality, but procedures are in place to protect your information. Finally, if you have any questions about this study or your rights as a participant, I can give you a telephone number to call. This completes the survey!

Spanish Version

At the Beginning of the Interview:

Hola, mi nombre es _________ y estoy llamando de parte del Servicio de Alimentos y Nutrición del Departamento de Agricultura de los Estados Unidos. Estamos llevando a cabo un estudio de investigación científica sobre las selecciones de comida de niños y sus familias.

La entrevista tomará aproximadamente unos 25 minutos. Tiene preguntas sobre las selecciones de comida de su hijo(a), así como preguntas generales sobre usted y su hogar. Sus respuestas ayudarán al gobierno a mejorar sus programas de nutrición de niños para niños de la edad de escuela. Como muestra de nuestra gratitud, le daremos una tarjeta de regalo de $10 (diez dólares) cuando terminemos.

Su participación en esta entrevista es voluntaria y puede parar en cualquier momento. Sus beneficios no serán afectados si usted elige no participar. Si usted toma parte, usted puede negarse a contestar cualquier pregunta. Si toma parte, sus respuestas no cambiarán ningún beneficio que usted pueda recibir de cualquier agencia.

Toda la información que nos proporcione será mantenida en forma confidencial en la medida permitida por la ley. Su nombre no será adjunto a ninguna de sus respuestas. Su información solamente será usada en combinación con información de otros hogares para análisis estadístico.

Tiene usted alguna pregunta antes de que empiece?

At the End of the Interview:

Si es seleccionado para recibir la tarjeta de Verano EBT, querríamos su permiso para mirar sus registros de cuándo y dónde utilizó su tarjeta [para Tejas y Michigan…y, qué tipos de alimento compró]. Esto nos ayudará a evaluar cómo trabaja el programa de Verano EBT.

[For sites with passive consent] Por último, también querríamos su permiso para que [name of school district] nos proporcione información de su solicitud para recibir Comida Gratis or Reducida de su hijo(a)/sus hijos así como alguna información administrativa del registro escolar de su niño(a). Estos datos incluirán cosas como la edad, nivel de grado y otra información administrativa. No incluirá información académica ni disciplinaria.

Sus registros sólo serán utilizados para este estudio. Serán mantenidos confidenciales hasta el punto requerido por la ley. Ningún conjunto de datos que resulte de este estudio le identificará a usted ni su niño(a). El permiso para ver/liberar sus registros es completamente voluntario, y usted puede negarse. Su decisión no cambiará ningún beneficio que pueda conseguir de alguna agencia. ¿Estaría dispuesto(a) a liberar estos registros?

Hay un riesgo mínimo en la participación en este estudio. El riesgo principal es una infracción de la confidencialidad pero hay procedimientos establecidos para proteger su información. Por último, si tiene cualquier pregunta acerca de este estudio o de sus derechos como participante, le puedo dar un número telefónico para llamar. ¡Esto completa la encuesta!

Process Study Instruments

(all interviews conducted in English)

As you may know, Abt and Mathematica are working together to evaluate the Summer EBT for Children demonstrations for the Food and Nutrition Service of USDA. My colleagues and I are visiting each of the five sites and collecting information from a wide range of stakeholders involved in the demonstration in order to learn about the process of implementation, the challenges you encountered, and lessons learned. I want to start by thanking you for taking time to speak with us today. Your perspective and insights on these issues are very helpful.

For stakeholders not receiving grant funds: Your participation is voluntary, and your responses will be kept confidential to the extent provided by law. You may refuse to answer any question and may stop the interview at any time.

Our reports to FNS will describe the range of responses expressed by staff, and may list the names of agencies and partners who contributed information, but we will not quote you or anyone by name or title. However, because of the relatively small number of organizations participating in the study, there is a possibility that a response could be correctly attributed to you.

I expect our conversation will take approximately [XX] minutes.

[OPTIONAL IF INTERVIEWER CHOOSES TO RECORD:] I want to be sure I am keeping track of everything you are saying. May I record our discussion so that I can listen to it later when I write up my notes? No one outside of our research team will have access to the recording. [IF YES:] Thank you. It will be helpful if you speak up, speak clearly, and speak one at a time. [IF NO:] That’s no problem. I’ll take notes as you talk, but I may sometimes need to ask you to slow down or repeat so that I can get all the information.

First, do you have any questions for me about the project in general or what we will be discussing today?