S - Consent

Attachment S

Interview Respondent Consent Form

Interview Respondent Consent Form

Respondent: Organization:

Interviewer: Date:

Introduction

Hello, I am __________and I am working with the Centers for Disease Control and Prevention (CDC) to conduct a study to understand how Colorado Works/Temporary Assistance to Needy Families (TANF) assist families and how their policies affect rates of child maltreatment. From your perspective at the State, we would like to learn more about Colorado’s policy to administer TANF programs with flexibility, and how this influences welfare and child welfare service models at the county level. The findings from this interview may be used to inform other agencies associated with integrated service delivery models.

This interview guide is designed to be inclusive and to help make sure we capture your feedback on a variety of topics. If there are questions that you don’t know the answer to, that is fine; just let us know and we can skip those questions.

Informed Consent

Before we begin, I would like to review a few points and confirm your permission to participate in this interview.

• This interview is completely voluntary.

• All of the information that we collect from you is secure and the only people that will have access to this information are the researchers who are conducting this study.

• We will not use your name in any reports about the interview. No quotes or comments you make will be linked with your name in any way.

• With your permission, we will be audio-recording the interview.

• You may choose to not answer certain questions or to not take part in the interview at any time.

• We expect this interview to take about one hour.

• If you have any questions, you may contact the principal investigator of this study, whose name and contact information is listed at the bottom of the consent form.

Do you agree to participate in the interview? (circle one) YES NO

Do I have your permission to record the interview? (circle one) YES NO