Informed Consent

Appendix C
Informed Consent and Link to Enter Survey
The Consumer Financial Protection Bureau (CFPB), a U.S. Federal government agency, has asked
the Corporation for Enterprise Development (CFED) and the Center for Financial Security (CFS)
at the University of Wisconsin Madison, to develop surveys that may later be used to gather
data on financial well-being and its drivers.
What is the purpose of this project?
The purpose of this project is to test financial well-being-related survey questions. As part of this
project, you will be asked to answer a roughly 17 minute online survey asking you about your
financial well-being and about your financial behavior and knowledge. Your answers will be
used to test the use of these questions for later surveys.
Privacy and Confidentiality
You will be asked to provide no information which directly identifies you as part of your
participation in this survey. Any directly-identifying information you have provided to Survey
Sampling International (SSI) as part of your pre-existing agreement to participate in this and
other surveys is available only to Survey Sampling International (SSI), not to the CFPB, and is
subject to the terms and conditions of those existing agreements [This will link to SSI privacy
policy]. Any answers you provide to the survey, including general demographic information such
as age and race, will be kept confidential, except as otherwise required by law. Additionally, the
Bureau will treat the information collected consistent with its confidentiality regulations at 12
C.F.R. Part 1070, et seq. Your responses, but not any information that directly identifies you, will
be combined with those of other survey respondents and shared for the purpose of analysis
with members of the study team which includes CFED, CFS and the CFPB along with
subcontractors and affiliates engaged in financial well-being-related research.
Among other things, the Dodd-Frank Act authorizes the CFPB to conduct research related to
consumer financial behavior and education. 12 USC § 5493(b)(1); id. § 5493(d)(3)(B); id.
5493(g)(3)(D).
Risks
There are few risks to you. This project involves you answering questions about your financial
knowledge, behavior and well-being. We recognize that you might be uncomfortable answering
some questions about finances or demographic information.
Right to Refuse or Withdraw
You may choose not to participate in the survey at any time. You may choose not to answer a
question for whatever reason by selecting the ‘refuse to answer’ option. Participation is
completely voluntary. Your incentive payment is, however, dependent on your completion of
the survey and subject to the terms of your agreement with SSI.

Benefits
Sharing your thoughts and ideas will help us and the CFPB better understand how to measure
the financial well-being of American consumers like you.
Paperwork Reduction Act
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and
a person is not required to respond to a collection of information unless it displays a valid OMB
control number. The OMB control number for this collection is XXXX. It expires on XX/XX/XXXX.
The time required to complete this information collection is estimated to average 17 minutes
per survey. The obligation to respond to this collection of information is voluntary. Comments
regarding this collection of information, including the estimated response time, suggestions for
improving the usefulness of the information, or suggestions for reducing the burden to respond
to this collection should be submitted to Bureau at the Consumer Financial Protection Bureau
(Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to
[email protected].
Contact Information
If you have questions about your rights as a participant, you may contact Anita Drever at the
Corporation for Enterprise Development at 202.207.0142 or [email protected].
If you consent to the survey, you may use the link below to begin. Selecting the link indicates
that you have read the above and agree to take part in this research.
Do you agree to the terms described above?
Yes : move forward
No: exclude