2015-16 NTPS Cog Labs Consent Form Change Request

NCES Cognitive, Pilot, and Field Test Studies System

Revised Attachment III 2015-16 NTPS Cog Labs Consent Form

2015-16 NTPS Cog Labs Consent Form Change Request

OMB: 1850-0803

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Attachment III (to be used when audio recording)


National Teacher and Principal Survey Consent to Participate in Research



Purpose. The National Teacher and Principal Survey (NTPS) is conducted by the National Center for Education Statistics (NCES) of the U.S. Department of Education. NORC at the University of Chicago, a research organization / CENSUS BUREAU, is under contract to NCES to develop the questionnaires. The purpose of this study is to evaluate the NTPS questionnaire items.


Procedures. If you agree to participate, NORC/ CENSUS BUREAU will ask you to complete some questionnaire items from the NTPS. NORC/ CENSUS BUREAU also will ask a series of debriefing questions that will help us revise the current questionnaire. Your responses will be completely confidential. The interview should take about 60 minutes.


Confidentiality. Your participation is voluntary and your responses may be used only for research purposes, to help improve the questionnaires, and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Education Sciences Reform Act of 2002, 20 U.S. Code, Section 9573). Your name will not be attached to the answers you provide.


Possible Risks and Discomforts. We do not anticipate any risks or discomforts for respondents. However, should you feel uncomfortable with any question asked you may skip the question or stop the interview at any time.


Voluntary Participation. Your participation is completely voluntary. A decision to not participate will not be held against you. If you agree to participate, you will receive a check for $40 as thank you for your time and input in the study.


Further Questions. If you have any questions about the project, you may call Lisa Lee at NORC at 312-759-4284.

If you have questions and would like to contact NCES directly, please contact Andy Zukerberg, Sample Surveys Division, at 202-219-7056.


With your permission, we would like to record this interview. The interview will be audio recorded to make sure we don’t miss anything that you say and to help us write a report summarizing the results of the interviews. Direct quotes may be used in reports or in research presentations, but your name will never be used in any reports or presentations. If you do not wish to be recorded you may still participate in the interview and will still receive $40 for your participation.


I have read and understand the statements above. I consent to participate in this study.


___________________________________ ___________________________

Participant's signature Date

___________________________________

Participant's printed name

________________________________

Researcher's signature


OMB Control Number: 1850-080



As a statistical agency devoted to collecting high quality statistics, we often conduct studies to improve our methods.  We sometimes present the results of this research to scientists interested in the study of questionnaire design in the form of slide shows with audio clips.  This slide show will be entrusted to the principal investigators on this research project and any distribution after presentation would not include the audio clips.   Please initial below if you give consent for us to use excerpts of your voice recordings for this purpose. If you do not wish to give this consent you may still participate in the interview and will still receive $40 for your participation.


____________ ______________

Initials Date




Attachment III (to be used when video recording)


National Teacher and Principal Survey Consent to Participate in Research



Purpose. The National Teacher and Principal Survey (NTPS) is conducted by the National Center for Education Statistics (NCES) of the U.S. Department of Education. NORC at the University of Chicago, a research organization / CENSUS BUREAU, is under contract to NCES to develop the questionnaires. The purpose of this study is to evaluate the NTPS questionnaire items.


Procedures. If you agree to participate, NORC/ CENSUS BUREAU will ask you to complete some questionnaire items from the NTPS. NORC/ CENSUS BUREAU also will ask a series of debriefing questions that will help us revise the current questionnaire. Your responses will be completely confidential. The interview should take about 60 minutes.


Confidentiality. Your participation is voluntary and your responses may be used only for research purposes, to help improve the questionnaires, and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Education Sciences Reform Act of 2002, 20 U.S. Code, Section 9573). Your name will not be attached to the answers you provide.


Possible Risks and Discomforts. We do not anticipate any risks or discomforts for respondents. However, should you feel uncomfortable with any question asked you may skip the question or stop the interview at any time.


Voluntary Participation. Your participation is completely voluntary. A decision to not participate will not be held against you. If you agree to participate, you will receive a check for $40 as thank you for your time and input in the study.


Further Questions. If you have any questions about the project, you may call Lisa Lee at NORC at the University of Chicago at 312-759-4284.

If you have questions and would like to contact NCES directly, please contact Andy Zukerberg, Sample Surveys Division, at 202-219-7056.


With your permission, we would like to record this interview. The interview will be video recorded to make sure we don’t miss anything that you say and to help us write a report summarizing the results of the interviews. Direct quotes may be used in reports or in research presentations, but your name will never be used in any reports or presentations. If you do not wish to be recorded you may still participate in the interview and will still receive $40 for your participation.


I have read and understand the statements above. I consent to participate in this study.


___________________________________ ___________________________

Participant's signature Date

___________________________________

Participant's printed name

________________________________

Researcher's signature




As a statistical agency devoted to collecting high quality statistics, we often conduct studies to improve our methods.  We sometimes present the results of this research to scientists interested in the study of questionnaire design in the form of slide shows with audio or video clips.  This slide show will be entrusted to the principal investigators on this research project and any distribution after presentation would not include the audio or video clips.   Please initial below if you give consent for us to use excerpts of your voice/video for this purpose. If you do not wish to give this consent you may still participate in the interview and will still receive $40 for your participation.


____________ ______________

Initials Date






































OMB Control Number: 1850-080


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