Consent Form

Consent Form

2020 Census Cognitive Interviews

Every ten years the Census Bureau conducts a census of the United States population. In preparation for this task, the Census Bureau conducts smaller tests in order to improve how data is collected. This 2020 Census Research interview is part of the effort to improve the 2020 Census.

______________________ [NAME] consents to take part in an interview to improve the Census in 2020. In order to have a complete record of all comments, the interview session will be audio-recorded. The Census Bureau plans to use the recordings to improve the next Census. Staff directly involved in the questionnaire design research project will have access to the recordings. Participation is voluntary and answers will remain strictly confidential. Interview participants are not allowed to discuss the interview discussion with people who did not participate in the interview.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have agreed to participate in this Census Bureau interview, and I give permission for my tapes to be used for the purposes stated above.

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Participant's Signature Researcher's Signature

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Printed Name Printed Name

___________________________ _______________________

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