Consent Form

Multilingual Research for 2020 Census Questionnaires

CONSENT FORM

The Census Bureau counts people in the U.S. Population. The purpose of this focus group is to evaluate the design and organization of selected questions in the census questionnaire to get the best possible information applicable to Puerto Rico. You are invited to participate voluntarily in this focus group, which is being conducted by RTI International (RTI), a not-for-profit research firm, and Research Support Services, Inc. (RSS), a contract research firm, for the Census Bureau. You are one of up to 90 people asked to participate in this study.

This focus group will take approximately 2 hours. During the group discussion, we will ask you to review some census questions and to discuss what you liked or disliked about them. Throughout the group discussion you can help us by describing anything you find confusing or difficult to understand. In appreciation for your participation in this project, you will receive $75.00 at the end of the group discussion.

In order to have a complete record of your comments, the focus group session will be audio and video recorded. We plan to use the recordings to improve the census questions. Only staff directly involved in the research project will have access to the recordings. We may also have members of the Census Bureau project team observe the group discussion.

While we would prefer that you answer all questions, you may skip any question or you may leave the discussion at any time. Your participation in this study is voluntary. Even if you choose not to participate, you will not lose any benefits or services that you may be receiving from any governmental agency. There are no direct benefits to you for participating in this study, but your answers will help the Census Bureau improve the questionnaires used for the decennial census.

RTI/RSS and the Census Bureau will keep your participation confidential, and the information you give us will be combined with the responses of others in a summary report that does not identify you individually. There are no expected risks to participating in this study. All information collected on you as a study participant is protected by Title 13 of the United States Code (Sections 141, 193, 221, and 223).

If you have any questions about the study you may telephone the RTI project director, Mandy Sha, at 1-800-334-8571, ext. 25266 (Ms. Sha speaks Spanish). If you have any questions about your rights as a research participant in this study, you may contact the Office of Research Protection at RTI International at 1-866-214-2043, a toll-free number.

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

I have volunteered to participate in this Census Bureau research study. I also give permission to have this session video and audio taped for the purposes stated above.

Signature of participant: __________________________________________________________ Date: ___/___/___

Signature of Person Who Obtained Consent: __________________________________________ Date: ___/___/___

Participant ID: _____________________________

OMB Control Number: 0607-0725

Expiration Date: 8/31/16