Appendix C_Disclaimer & Informed Consent

Appendix C: Disclaimer and Informed Consent

Exhibit C-1. Disclaimer

Disclaimer

Tufts University is collecting feedback on behalf of the US Department of Agriculture Economic Research Service (ERS) to evaluate the National Household Food Acquisition and Purchase Survey (FoodAPS) from a data user’s perspective. Feedback from FoodAPS researchers will assist ERS in improving data collection efforts for the next round of FoodAPS.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is [0536-0073] (expires 01/31/2019). This information collection is conducted under the authority of 7 U.S.C. 2204(a).

This information collection asks FoodAPS data users to report on: 1) motivations for using the dataset, 2) data components you used, and 3) recommendations for future data collection efforts. We expect that completing the survey will take approximately 60 minutes of your time. This estimate includes 30 minutes for the survey itself and 30 minutes for reviewing instructions, corresponding with us via email and answering questions, either via email or telephone. Your participation in this information collection is voluntary.

This study does not ask you for any personal information. ERS intends to protect respondent information under the Privacy Act of 1974 and 7 U.S.C. 2276.

Exhibit C-2. Informed Consent Form.

Informed Consent Form

Principal Investigator

Parke Wilde, Ph.D.

Friedman School of Nutrition Science and Policy, Tufts University

[email protected] | 617-636-3495

150 Harrison Avenue, Boston, MA 02111

Purpose

Thank you for your willingness to participate in this feedback collection effort. The purpose of this research is to evaluate the National Household Food Acquisition and Purchase Survey (FoodAPS) from a data user’s perspective. We will compile your feedback, along with input from other participants, into a report to the U.S. Department of Agriculture Economic Research Service (USDA/ERS). USDA/ERS will use this report to inform the design and data collection for the next round of FoodAPS.

Duration

Participation in this feedback collection effort entails either completing a questionnaire via email or an interview via telephone. We anticipate that this will take 60 minutes of your time, including 30 minutes for the survey in writing or by telephone and 30 minutes for additional tasks including corresponding with us and additional questions, by email or telephone.

Benefits and Risks

Although your participation in this research may not yield any direct benefits, there may be indirect benefits of participation. With your input, USDA/ERS may be able to improve design, data collection, and data availability for the next round of FoodAPS. Improvements to the survey and dataset will allow other researchers using future iterations of FoodAPS to investigate consumer food shopping behaviors, household well-being, and healthy food access, using improved data. We do not foresee any risks involved with completing a questionnaire or interview. Questions are non-sensitive, and your responses will not put you at risk of liability or other damages.

Confidentiality

Your participation is confidential. We will store your responses electronically, and only study personnel will have access to this data. We will store identifying information, including your name, email address, and telephone number, with your responses if we receive them via email. Keeping your identifying information linked to written responses will allow us to follow up with you if needed. We will decouple identifying information from your questionnaire responses once we complete follow-up questioning as needed. The original document containing your linked identifying information will be deleted, and we will save a new, de-identified document with your responses in our password-protected document storage system. Our final report to USDA/ERS will discuss feedback in aggregate form only and will not attribute responses to particular individuals.

Information Requests

Should you have any questions or concerns about this feedback collection effort, you may contact us at any time. The principal investigator may be reached via email at [email protected] or via telephone at 617-636-3495. You also are welcome to contact Lara Sloboda at Tufts University Office of the Institutional Review Board at 617-627-3417.

Withdrawal of Participation

Your participation also is voluntary. You may skip questions as you wish and may discontinue participation at any time. Deciding to withdraw or refusing participation altogether will not result in any penalties or modifications to your FoodAPS project agreement.

Signature

I confirm that I understand the purpose of the research and study procedures. I understand that I may ask questions at any time and can withdraw from the study without consequences. I have read this informed consent form, and my typed name below affirms my willingness to participate in this study.

Typed Signature Date

Principal Investigator Signature Date

Printed Name of Principal Investigator

Exhibit C-3. Verbal Consent Form

INFORMED CONSENT FORM: VERBAL CONSENT

Thank you for your willingness to participate in this feedback collection effort. The purpose of 
this research is to evaluate FoodAPS from a data user’s perspective. We will compile your 
feedback, along with input from other participants, into a report to the U.S. Department of Agriculture Economic Research Service, or USDA/ERS. USDA/ERS will use this report to inform the design and data collection for the next round of FoodAPS. 

We anticipate that this telephone call will take 30 minutes to complete. Your participation in this interview is both confidential and voluntary. Should you choose to stop the interview at any time, you may do so without penalty. 

In our initial email correspondence with you, we sent you an informed consent form and disclaimer, describing additional information about confidentiality and benefits and risks of study participation. We anticipate no risks to you from participating in this interview. The emailed informed consent form also contains contact information for the principal investigator as well as the Tufts University Institutional Review Board administrator. 

We will re-send that informed consent form to you along with a scanned, signed copy of this statement. Please keep these forms for your records. 

Do you agree to participate in this study? Yes No  Initial ______   

Do we have your permission to record this telephone call?    Yes  No  Initial ______