Initial Survey Contact

Social Indicators in Coastal Alaska: Arctic Communities

Consent Form

CONSENT TO PARTICIPATE IN RESEARCH

You are asked to participate in a research study conducted by Stephen Braund & Associates for the U.S. Department of the Interior, the Bureau of Ocean Energy Management or BOEM for short. BOEM is responsible for managing offshore energy exploration and development. BOEM’s responsibilities include monitoring the impacts of development on North Slope residents and taking steps to reduce any impacts.

PURPOSE OF THE STUDY

The purpose of the Social Indicators Study is to measure the well-being of North Slope residents so that any impacts of offshore oil and gas exploration and development can be identified and mitigated.

PROCEDURES

Your participation in this research project is voluntary. The interview is anonymous and takes about 1 hour. We will pay you $50 for your participation. If we get to a question that you don’t wish to answer, just say “pass.”

POTENTIAL RISKS AND DISCOMFORTS

You may feel uncomfortable with some of the questions in this survey. We have placed the most sensitive questions in a self-administered part of the interview. We also use cue cards so that you can give your answers by selecting a letter indicating your response choice. As noted above, if we get to a question that you don’t wish to answer, just say “pass.” We will not identify you or your household.

ANTICIPATED BENEFITS TO SUBJECTS

The 1953 OCS Lands Act requires BOEM to monitor and assess, and if possible mitigate, impacts of resource development on the human environment. This study will produce baseline data to accomplish this legal requirement. It may help BOEM to avoid or reduce impacts of development. However, you should not expect to benefit directly from participation in this research. You are important to the goal of building an accurate picture of well-being on the North Slope. Are you willing to be interviewed?

► Yes ► No If NO, stop interview. If YES, read the Paperwork Reduction Act Statement.

49010201 1 Stephen R. Braund & Associates