Appendix C -- Cons Consent Form

Appendix C: Consent Form

OMB Control Number: 1220-0141

Expiration Date: April 30, 2018

CONSENT FORM

The Bureau of Labor Statistics (BLS) is conducting research to increase the quality of BLS surveys. This study is intended to suggest ways to improve the procedures the BLS uses to collect survey data.

The BLS, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. The Privacy Act notice on the back of this form describes the conditions under which information related to this study will be used by BLS employees and agents.

During this research you will be observed.

We estimate it will take you an average of 60 minutes to participate in this research.

Your participation in this research project is voluntary and you have the right to stop at any time. If you agree to participate, please sign below.

Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. The OMB control number is 1220-0141 and expires April 30, 2018.

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

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Participant's signature Date

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Participant's printed name

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Researcher's signature