Consumer Response Intake Form Improvement Study

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.

Wh y is this study being done?

This interview is being done to determine the ideal design of a website designed for adults across the United
States. Receiving feedback on the website will lead to design solutions that enhance the website’s functionality
and optimize its user experience.

Wh at d o I n eed to kn ow ab ou t th is s tu d y?

This opportunity is being offered to adults (18 years and older) in the Washington, DC area. Interviews will take
place October 2nd & 3rd. Each interview will last approximately 60 minutes and you will work one-on-one with a
moderator. The interviews will be video recorded, and 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
3170-0042. Without this approval, we could not ask these questions.
Participants will be asked to interact with and provide feedback on a website. While they do so, where they look on
the screen will be tracked. The moderator will ask questions while the participant completes assigned activities
using the website. Participants will then discuss their thoughts and opinions about the website with the moderator.
Other researchers may observe in another room.

Wh at are th e poten tial ris ks of b ein g in th e web s ite feed b ac k in terview?

There are minimal risks associated with this study. Participants will complete short questionnaires and provide
feedback about the website.. Participants’ eye movements will be tracked using a state-of-the art eye tracker
which utilizes small video cameras. You do not have to answer any questions that you do not wish to answer.

Does being in this study provide any benefit?

Participants will be compensated $75 for their participation in the interview. When the feedback from the
interviews is applied to the website, it will make it easier for users to access and utilize the website’s services.

Will it cost me anything to be in this study?

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

Do I have to be in this study?

Your participation is voluntary. There are no penalties associated with refusal to participate; however your
participation is encouraged so as to get a wider range of feedback from users.

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

Only the staff working on this project will have access to the information you provide in the interview.

Wh o do I contact if I have questions about the study?

If you have questions or concerns about the interview, you can contact
Jonathan Strohl, Fors Marsh Group, [email protected], 571-858-3803.
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