Financing an Auto - External testing

INFORMED CONSENT AND INFORMATION PROTECTION FORM
You are being asked to participate in a research study. This form describes the purpose, procedures, risks, benefits and
requirements of the study. It describes your right to withdraw from the study at any time. A member of the study staff is
available to read through this form with you and discuss all the information, if you wish.

Why is this study being done?

FMG has a client with a website. This study is being done to determine the ideal design of that website. Receiving feedback on
the website will lead to better design, functionality, and overall user experience.

How does this work?

This opportunity is offered to adults (18 years and older) throughout the U.S. The study involves one-on-one interviews between
you and a moderator, each interview lasting approximately 60 minutes. We will ask you for your name, email address, telephone
number, and demographic information. You will be asked to view or input information on a computer screen and to discuss your
thoughts and opinions while viewing or inputting information. The interview, including the screen and your inputs, will be video
recorded. Other researchers may observe the interview in another room. If you choose to participate, you will be compensated
$75 for the interview. Plus, your feedback will help us and our clients improve service delivery to customers like you.
In accordance with the Paperwork Reduction Act of 1995, the questions asked as part of this study have been approved by the
Federal government’s Office of Management and Budget (OMB) under OMB control number 3170-0024. Without this approval,
we could not ask these questions.

What are the risks or costs of being in the study?

There are minimal risks and costs associated with this study. After agreeing to participate, we will record your personal
information and record you during the interview. But your personal information is not associated with your responses. We only
take your personal information to identify that you participated and to pay your compensation, as discussed below. You do not
have to answer any questions that you do not wish to answer. There are no costs to you, other than your transportation costs
arriving at the location.

Do I have to be in this study?

Your participation is voluntary. There are no penalties associated with refusal to participate. However, your participation is
encouraged to help us get the best results.

Who will have access to this study or my information?

Only the staff working on this project will have access to the information you provide in the interview.

Can I tell others about the product I will be discussing?

We do require that you do not disclose the information you learn during the interview. You will learn about certain design
features and functionality of a product that is currently not available to the public. Our clients consider this information
confidential. Agreeing to participate means agreeing to keep the information confidential.

Who do I contact if I have questions about the study?

If you have questions or concerns about the interview, you can ask the interviewer or you can contact:
Jonathan Strohl, Fors Marsh Group, [email protected], 571-858-3803.
I, _______________________________________, have read this form and agree to participate in this study.
Print Name
_________________________________________________________________________________________
Participant’s Signature Date
_________________________________________________________________________________________
Researcher’s Signature Date

1010 N. Glebe Road, Suite 510 | Arlington, Virginia 22201 | www.forsmarshgroup.com