Form NHTSA Form 1403 NHTSA Form 1403 Informed Consent

OMB Control No. 2127-0682

Expiration Date 04/31/2018

Informed Consent

Motorcycle Rider Focus Group Study

Thank you for agreeing to participate in this research study. Your participation in the study will take about 1 hour and 40 minutes. This study is being conducted on behalf of the National Highway Traffic Safety Administration (NHTSA). Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control number. The OMB control number for this study is 2127-0682. Your participation is voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

1. You are being invited to take part in a research study on motorcycle riding because you ride a motorcycle and you are 18 years or older. The purpose of the study is to gather information on the opinions and attitudes of motorcycle riders on rider gear and apparel. Your participation would be for a one-time focus group of about 90 minutes duration, however this consent form and a screener process totaling another 10 minutes. The group will consist of about 6 to 10 riders, and will be led by an experienced focus group moderator.

2. The study is being conducted by Westat, a research firm based in Maryland. It is funded by the Department of Transportation.

3. If you agree to be in the focus group the following things will happen:

   1. The moderator running the group will introduce the topic and provide some ground rules to help everyone feel comfortable with the discussion.

   2. You will be asked to review and sign this informed consent form.

   3. You will have the opportunity to discuss your views and attitudes on riding gear and other related topics. The session will be recorded with a digital recorder (like a tape recorder) so that the moderator running the focus group can pay close attention to what is being said at the time.

   4. The recordings will be used by Westat and the Department of Transportation to review the session. You personnlly will never be linked to the recording and the recording will never be made public. The recordings will be destroyed at the conclusion of the research.

   5. After the focus group has ended and before you leave, Westat will give you $75 to thank you for your time.

   6. Your participation is voluntary, and you may agree or refuse to participate. If you agree to participate, you can stop at any time during the study without explanation.

4. Confidentiality. No reports, whether published or not published, will identify focus group participants. Likewise, all information collected during the study is confidential to the fullest extent of the law and will not be presented in any form that would reveal your identify or any participant’s identity.

5. Risks. This study does not involve any foreseeable risks.

6. Benefits. There are no direct benefits to you.

7. Questions. If you have any questions or concerns about this study, please contact:

James Jenness, PhD.

(240) 314-2424

Westat

1600 Research Boulevard

Rockville, MD 20850

If you have any questions about your rights and welfare as a research participant, call the Westat Human Subjects Protection office at 1-888-920-7631 and leave a message with your name and the name of the study, “Motorcycle Focus Group Study”, and a phone number beginning with the area code. Westat will return your call as soon as possible.

Authorization. By signing this form, you certify that you have read this form and that you agree to take part in the study.

(If you accept these terms, please indicate your consent below)

I _____________________ (participant’s name) have received information about being involved in the Motorcycle Focus Group Study. I have read this form, I understand it, and my questions have been answered. I agree to participate in the study.

__________________________________ _________________

Participant Signature Date

Statement of Person Who Obtained Consent

I have discussed the above points with the participant. It is my opinion that the participant understands the risks, benefits, and procedures involved with participation in this research study.

______________________________ _________________

Westat Employee Who Obtained Consent Date

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