Expiration Date XX/XX/XXXX
We invite you to take part in a research study to relate your experiences as a recent buyer of an automobile.
Someone will explain this research study to you, including:
The nature and purpose of the research study.
The procedures to be followed.
Any common or important discomforts and risks.
Any benefits you might expect.
Whether or not you take part is up to you.
You can choose without force, fraud, deceit, duress, coercion, or undue influence.
You can choose not to take part.
You can agree to take part now and later change your mind.
Whatever you decide it will not be held against you.
You can ask all the questions you want before you decide.
If you agree to take part, you will be given a signed and dated copy of this document.
If you agree to take part, you will be given a copy of this document.
If you have questions, concerns, or complaints, or think the research has hurt you, talk to the research team. You may contact Ken Kurani at [email protected]
This research has been reviewed and approved by an Institutional Review Board (“IRB”). Information to help you understand research is on-line at http://www.research.ucdavis.edu/IRBAdmin.You may talk to a IRB staff member at (916) 703-9151, [email protected], or 2921 Stockton Blvd, Suite 1400, Room 1429, Sacramento, CA 95817 for any of the following:
Your questions, concerns, or complaints are not being answered by the research team.
You cannot reach the research team.
You want to talk to someone besides the research team.
You have questions about your rights as a research subject.
You want to get information or provide input about this research.
The purpose of this research is to compare the real experience of households’ car purchases and use to the models of such behaviors. Various government agencies use such models to estimate how many and what kinds of cars and trucks will be sold in coming years, how much fuel will be used, and how many miles will be driven. There is considerable discussion among industry, government, and academic researchers about how well these models represent consumers. The results of this research will inform these discussions. Further, some government agencies will use this information to provide information back to consumers, such as through the website fueleconomy.gov that is jointly administered by the US Department of Energy and the Environmental Protection Agency. This website allows consumers to compare their real-world fuel economy to the fuel economy estimates posted on every new car sold.
This research is based on interviews with households in their homes. We expect that each interview will last up to 2 hours.
54 households will be interviewed. If there are between one and two individual household heads in each interview then we expect between 54 and 108 people here will be in this research study.
You will have a conversation with two researchers; this conversation will last no more than two hours. We’ll ask that if there is someone else in your household that shares decisions about automobile purchases, that they take part in the interview, too. You will talk about your household’s automobile purchases, describing the vehicles you bought, how you came to buy that vehicle, and your plans for future car purchases.
The timeline for completing all the household interviews is about seven months. The entire research project will take ten months to one year.
If you take part in this research, you will be responsible to engage in the interview.
You may decide not to take part in the research and it will not be held against you.
You can leave the research at any time and it will not be held against you.
If you stop being in the research, already collected data may not be removed from the study database.
Efforts will be made to limit use and disclosure of your personally identifiable information, including your name, address, e-mail address, and phone number. Those efforts include both limiting the time we hold your personal information, who has access to it, and how they may access it. As your personally identifiable information are required only to schedule and complete your interview, once the household interviews have been completed, your name will be replaced with a pseudonym, your phone number and e-mail address will be securely deleted, as will your address except that your zip code will be saved. Access to the research study records, for example the notes and recordings from your interviews, will be limited to people who have a need to review this information. We cannot promise complete confidentiality. Organizations that may inspect and copy your information include the UC Davis IRB and other University of California representatives responsible for the management or oversight of this study.
This research is being funded by the United States Department of Energy.
If you agree to take part in this research study, we will compensate your household $100 for each participating adult member, up to two adult members for your time and effort. You may be asked for your social security number for payment purposes. It will not be used for any other purpose without your permission.
Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to promote vehicle fuel economy. The U.S. Department of Energy (DOE) is required under U.S. Code, Title 49, Section 32908(c)(3) and (g)(2)(A) to publish and distribute the annual Fuel Economy Guide and to provide “consumer education” about vehicle fuel economy. To further promote consumer education, DOE also developed and maintains the associated website www.fueleconomy.gov. The data you supply will be summarized and made available to consumers at no cost through the Fuel Economy Guide and www.fueleconomy.gov. The summarized data will be used to provide consumers with information that will help them value increased fuel economy as a means of reducing petroleum consumption, saving money on fuel, and reducing greenhouse gas emissions.
Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records & Privacy Management Division, IM-23, Paperwork Reduction Project No. 1910-New , U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project No. 1910-New, Washington, DC 20503.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.
Submission of this data is voluntary.
Signature Block for Capable Adult
Your signature documents your permission to take part in this research. |
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For IRB Use
Document Revision Date: July 23, 2013 |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | : RP-502 - TEMPLATE CONSENT DOCUMENT |
| Subject | Huron HRPP ToolKit |
| Author | Jeffrey A. Cooper |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |