H - Participant Information Sheet

U.S. Department of Health and Human Services (HHS)

Centers for Disease Control and Prevention (CDC)

Qualitative information collection on emerging diseases among the foreign-born in the United States

Participant Information Sheet

Purpose of the Talk

You are invited to share your thoughts in a discussion held today by the Centers for Disease Control and Prevention, or CDC. CDC is part of the U.S. government, Department of Health and Human Services. The {contractor} will also help in leading this discussion. During the discussion, we will ask you to tell us what you have heard or think about one or more of the following health topics [INSERT HEALTH TOPIC HERE]. There is no right or wrong answer; every response teaches us something. Your answers can help us to better inform others in your community about these health topics in the future.

If you agree to participate

You will be asked to: Take part in a 45-minute discussion about the health topic Allow the discussion to be recorded on audio tape

Risks

The risks in participating in the discussion are the same as you face in your daily life. While we would like to hear what you think, you do not have to participate and you can decide to leave at any time. No information about your participation will be shared with anyone outside the small group working on these issues. Any notes and the audio recordings will be destroyed after 3 years. If you are worried about your privacy, you can use a different name during this discussion.

Benefits

During today’s discussion, you will learn more about a major health issue. You will also be helping others by sharing your thoughts during this discussion. We will use your feedback to provide better health information to you, your families, and your communities in the future.

Privacy

None of the information being collected is of a personal nature. We will protect this information to the extent allowed by law. We will not keep a written record of your name, and the information you share will not be used in any report so that you can be identified. By agreeing to participate, you agree to let us audio record today’s discussion. We will destroy the audio recording after 3 years. While we ask that the other participants do not talk about what we discuss today outside of the group, there is the possibility that they might talk and so we cannot guarantee complete privacy in this case.

Persons to Contact

If you have any questions about the talk, you may call: [INSERT CDC CONTACT HERE]. If you have questions about your rights as a participant, you can contact: [INSERT CONTRACTORS CONTACT HERE]